Association Between Weight Loss Before Deceased Donor Kidney Transplantation and Posttransplantation Outcomes

Rationale & Objective There is debate on whether weight loss, a hallmark of frailty, signals higher risk for adverse outcomes among recipients of deceased donor kidney transplantation (DDKT). Study Design Retrospective cohort study. Setting & Participants Using national Organ Procurement and Transplantation Network data, we included all DDKT recipients in the United States between December 4, 2004, and December 3, 2014, who were adults (aged ≥ 18 years) when listed for DDKT. Exposures Relative pre-DDKT weight change as a continuous predictor and categorized as Outcomes We examined 3 post-DDKT outcomes: (1) transplant hospitalization length of stay (LOS) in days, (2) all-cause graft failure, and (3) mortality. Analytic Approach Unadjusted fractional polynomial methods, multivariable log-gamma models, and multivariable Cox proportional hazards models. Results Among 94,465 recipients of DDKT, median pre-DDKT weight change was 0 (interquartile range, −3.5 to +3.9) kg. There were nonlinear unadjusted associations between relative pre-DDKT weight loss and longer transplant hospitalization LOS, higher all-cause graft loss, and higher mortality. Compared with recipients with  P  = 0.003), 1.11-fold higher graft loss (adjusted HR [aHR], 1.11; 95% CI, 1.06-1.17; P P P Limitations Unmeasured confounders and inability to identify volitional weight change. Also, the higher significance level set to increase the power of detecting interactions with the fixed sample size may have resulted in increased risk for type 1 error. Conclusions DDKT recipients with ≥10% pre-DDKT weight loss are at increased risk for adverse outcomes and may benefit from augmented support post-DDKT.