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Body mass index, weight-adjusted immunosuppression and the risk of acute rejection and infection after kidney transplantation: A cohort study

Nephrology Dialysis Transplantation Dec 11, 2019

Flabouris K, et al. - Given body mass index (BMI) is related to patient outcomes following kidney transplantation, researchers investigated whether immunosuppression (IS) dosing represents a contributing factor. For this purpose, they performed this study including all adult kidney-only transplant recipients over 2000–14 managed with prednisolone, mycophenolate and tacrolimus/cyclosporin (n = 7,919) identified from Australia and New Zealand Dialysis and Transplant registry. Following adjustment for demographics and comorbidities, a BMI of 35 vs a BMI of 25 kg/m2 was found to be related to acute rejection. The virtual vanishing of this link was noted after correcting for IS. They also found that a BMI of 35 was non-significantly related to fewer fatal infections, but this reversed following adjusting for IS. According to the findings, the correction for IS resulted in a significant change in the links between high BMI, acute rejection and fatal infection following kidney transplantation. This indicates that relative under-dosing of obese patients may in part explain these links.
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