P SUBRAMANI1, S ULLAH2,3,4, W MAJONI5,6,7, J HUGHES2,5,6,7, S MCDONALD1,2,3
1Central Northern Adelaide Renal and Transplantation Services, Royal Adelaide Hospital, Adelaide, Australia, 2Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, Australia, 3University of Adelaide School of Medicine, Faculty of Health and Medical Sciences, Adelaide, Australia, 4South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia, 5Department of Nephrology, Royal Darwin Hospital, Darwin, Australia, 6Menzies School of Health Research, Wellbeing and Preventable Chronic Diseases, Darwin, NT, Darwin, Australia, 7Flinders University Faculty of Medicine, Nursing and Health Sciences, Northern Territory Medical Program, Darwin, Australia
Aim: To compare the association of body mass index (BMI) change in the first year post kidney transplantation with graft and patient survival in Indigenous and non-Indigenous Australians.
Background: Significant post-transplant weight loss or gain is associated with poorer transplant outcomes in non-Indigenous Australians. There is little data comparing early weight change with outcomes between Indigenous and non-Indigenous recipients.
Method: ANZDATA Registry data was used to examine these issues. All adult patients (aged 18+) who received a deceased donor primary kidney-only transplant from 1997-2016 were included. Percentage BMI change at 1-year post transplant was calculated. Outcomes were death censored graft loss and death with functioning graft. The associations were analysed using multivariate Cox proportional hazard models with confounder adjustments.
Results: A total of n=6776 non-Indigenous and n=387 Indigenous recipients were included in this study. Over half the recipients in both groups gained BMI in the first year; 23.1% non-Indigenous and 22.3% Indigenous lost BMI. The risk of graft loss and death were increased in the >10% and 5-10% BMI loss categories (adjusted HR 1.9 (1.6-2.4) and 1.5 (1.2-1.8) respectively (p <0.001) for graft loss and 1.8 (1.4-2.3) and 1.4 (1.1-1.8) respectively (p <0.01) for death) in the non-Indigenous group. These risks were greater (HR 3.0 (1.4-6.5) and 2.6 (1.3-5.3) (p<0.01) for graft loss and 2.1 (0.9-5.1) (p = 0.10) and 3.0 (1.4-6.6) (p<0.01)) in the Indigenous group. There was no increase risk in graft loss or death associated with BMI gain.Conclusion: BMI loss following kidney transplantation is associated with poor survival outcomes with a greater effect amongst Indigenous recipients. BMI loss can therefore be used as a risk marker of outcome in clinical practice.
Conclusion: BMI loss following kidney transplantation is associated with poor survival outcomes with a greater effect amongst Indigenous recipients. BMI loss can therefore be used as a risk marker of outcome in clinical practice
Biography: Priyanka Subramani is currently a final year nephrology trainee at Royal Adelaide Hospital, having spent two years in the Northern Territory, prior to that. Having completed her undergradate medical degree at The University of Adelaide in 2010, she went on to pursue a career as a physician at Monash Health. She has a keen interest in Indigenous health and developing world medicine and is looking to further her experience abroad next year.