Ducloux D et al. (2005) One-year post-transplant weight gain is a risk factor for graft loss. Am J Transplant 5: 2922–2928

A retrospective analysis of data from a university hospital in France has excluded METABOLIC SYNDROME as an independent determinant of renal transplantation outcome, but has revealed that substantial weight gain—which is common after transplantation—independently increases the risk of graft loss. Management of post-transplantation BMI should therefore be a priority.

One year following kidney transplantation, mean weight gain for the 292 graft recipients included in the study was 2.7 ± 5.8 kg. After adjusting for confounding variables, such as baseline BMI or metabolic syndrome, transplant recipients whose BMI increased by more than 5% (n = 127) had a significantly augmented risk of graft loss (HAZARD RATIO 2.82, 95% CI 1.11–7.44, P = 0.015 when censored for death). By contrast, there was no association between graft loss and metabolic syndrome, independent of the confounding effects of other factors such as serum C-REACTIVE PROTEIN level.

Interestingly, 1-year post-transplant weight gain in excess of 5% was less common in peritoneal dialysis patients than those on hemodialysis (P = 0.003). Ducloux et al. propose that higher LEPTIN and lower GHRELIN plasma levels in peritoneal dialysis patients reduced their appetite.

Attenuating weight gain using drugs or by regulating caloric intake might improve the outlook for kidney transplant recipients, but potential interventions first need to be tested in prospective trials.