Effect of Pretransplant Recipient Body Mass Index on Pancreas Allograft Outcomes: A Seven-Year Cohort

Background: Obesity is associated with inferior allograft and patient survival following solid organ transplantation. Here, we evaluated the impact of pre-transplant body mass index (BMI) on both early and late pancreas graft survival outcomes among simultaneous pancreas-kidney (SPK) recipients. Methods: The data was curated from the United Network for Organ Sharing (UNOS) database. 7195 transplants met the eligibility criteria. The cohort analyzed SPK transplants performed between 2015 and 2023 divided into three BMI categories: normal (BMI 18.5-24.9 kg/m, reference group), overweight (BMI 25-29.9 kg/m), and obese (BMI ≥30 kg/m), utilizing univariate and multivariate Cox regression analyses. Results: Pancreas graft failure was classified as early (within 90 days post-transplant) or late (91 days to 5 years post-transplant). The median pre-transplant BMI among recipients was 25.6 kg/m (IQR 23.0–28.4), with 76.8% having type 1 diabetes and 22.2% type 2 diabetes. Both overweight and obesity were independently associated with an increased risk of early pancreas graft failure (HR 1.27; 95% CI 1.02–1.59; p = 0.03 and HR 1.69; 95% CI 1.30–2.20; p < 0.001, respectively) (Fig. 1). Pre-transplant BMI was not significantly associated with late graft failure across BMI categories (overweight: HR 1.07; p = 0.48; obese: HR 1.18; p = 0.20) (Fig. 2). Conclusion: This study highlights the significant impact of pre-transplant recipient body weight on early pancreas allograft outcomes.