CLINICAL AND TRANSLATIONAL RESEARCH Obesity Was Associated With Inferior Outcomes in Simultaneous Pancreas Kidney Transplant Marcelo Santos Sampaio, 1,2 Pavani Naini Reddy, 1 Hung-Tien Kuo, 1,3 Neda Poommipanit, 1 Yong Won Cho, 3 Tariq Shah, 3 and Suphamai Bunnapradist 1,5 Background. In kidney transplant, obesity was reported to be associated with increased posttransplant complications and worse survival outcomes. The impact of obesity in simultaneous pancreas-kidney (SPK) transplant is less known. Methods. Using Organ Procurement Transplantation Network/United Network for Organ Sharing data as of August 2008, we included all adults (18 years) type 1 diabetic SPK recipients between years 2000 and 2007 with a pretrans- plant body mass index (BMI) of 18.5 to 40 kg/m 2 . The cohort was divided in three groups: normal (BMI 18.5–24.9 kg/m 2 , reference group), overweight (BMI 25–29.9 kg/m 2 ), and obese (BMI 30 – 40 kg/m 2 ). Covariate-adjusted relative risk of a combination of posttransplant complications and patient, pancreas and kidney allograft outcomes were evaluated. Results. Of 5725 recipients, 56%, 33%, and 11% were in normal, overweight, and obese groups, respectively. Over- weight and obese recipients were older, had a higher percent of coronary artery disease, and private health insurance coverage. Overall posttransplant complications were higher in obese group (35.7% vs. 28.6%) when compared with normal BMI group. They were mainly due to increased delayed kidney graft function (11.8% vs. 7.4%), 1-year kidney acute rejection (17.0% vs. 12.1%), and pancreas graft thrombosis (2.6% vs. 1.3%). After adjusting for possible con- founders, the odds ratios for overall transplant complications were 1.03 (95% confidence interval [CI]: 0.90 –1.17) for overweight and 1.38 (95% CI: 1.15–1.68) for obese. Obesity, but not overweight, was associated with patient death (hazard ratio [HR]: 1.35; 95% CI: 1.00 –1.81), pancreas graft loss (HR: 1.41; 95% CI: 1.17–1.69), and kidney graft loss (HR: 1.33; 95% CI: 1.05–1.67) at 3 years. The higher rates of death and graft failure in the first 30 days posttransplant mostly accounted for the 3-year survival differences. Conclusion. Obesity in SPK recipients was associated with increased risk of posttransplant complications, pancreas and kidney graft loss, and patient death. Keywords: Kidney transplant, Pancreas transplant, Body mass index, Transplant complications, Type 1 diabetes mel- litus, UNOS. (Transplantation 2010;89: 1117–1125) T he prevalences of overweight (body mass index [BMI] 25–29.9 kg/m 2 ) and obesity (BMI 30 kg/m 2 ) have been increasing in dialysis patients and kidney transplant candi- dates. In 2001, 60% of patients with end-stage renal disease (ESRD) at the time of kidney transplant were obese or over- weight, with the proportion of obese recipients increased from 11.6% in 1987 to 25.1% in 2001 (1). Obesity was shown to be associated with worse out- comes in the majority of the studies in kidney transplant alone (2–4). The data on the impact of obesity on simulta- neous pancreas-kidney (SPK) transplant outcomes are lim- ited and most of them derived from single-center analyses. Obesity was associated with increased posttransplant compli- cations in two of the four studies (5–7) and in only one of them obesity was associated with worse survival outcomes (8). Using Organ Procurement Transplant Network/ United Network for Organ Sharing (OPTN/UNOS) data- base, we investigated the impact of obesity on posttransplant This work was supported, in part, by Health Resources and Services Admin- istration contract 234-2005-370011C. The authors declare no potential conflict of interest. Data reported here have been taken from Organ Procurement Transplant Network/United Net- work of Organ Sharing (OPTN/UNOS) as of August, 2008. Dr. Marcelo Sampaio participation in this work has been made possible through an International Society of Nephrology funded fellowship. Ab- stract related to this manuscript was accepted as a poster at the Renal Week Congress from America Society of Nephrology (San Diego, 2009). 1 Division of Nephrology, Kidney and Pancreas Transplant Program, David Geffen School of Medicine at UCLA, Los Angeles, CA. 2 Division of Nephrology, Pedro Ernesto University Hospital, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil. 3 Division of Nephrology, Kaohsiung Medical University Hospital, Kaohsi- ung Medical University, Kaohsiung, Taiwan. 4 Mendez National Institute of Transplantation, Los Angeles, CA. 5 Address correspondence to: Suphamai Bunnapradist, M.D., 924 Westwood Boulevard, Suite 200, Los Angeles, CA 90095. E-mail: bunnapradist@mednet.ucla.edu All authors contributed to the design, performance of the research, data analysis, and writing the article. Received 8 December 2009. Revision requested 8 December 2009. Accepted 14 December 2009. Copyright © 2010 by Lippincott Williams & Wilkins ISSN 0041-1337/10/8909-1117 DOI: 10.1097/TP.0b013e3181d2bfb2 Transplantation • Volume 89, Number 9, May 15, 2010 www.transplantjournal.com | 1117