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One‐Year Post‐Transplant Weight Gain is a Risk Factor for Graft Loss

Metabolic syndrome (MS) and obesity participate in the pathogenesis of kidney disease. We explored the impact of MS and post‐transplant weight gain on graft survival. Two hundred ninety‐two renal transplant recipients (RTRs) were included in the study. Various parameters (e.g. anthropometric, biological) were measured at the time of transplantation as well as 1 year post‐transplant. The proportion of patients with overweight or obesity significantly increased during the first year post‐transplant (p = 0.04). Mean weight gain was 2.7 ± 5.8 kg. Thirty patients (10.3%) lost their graft during follow‐up. In multivariate analysis, patients with an increase in body mass index (BMI) of more than 5% at 1 year post‐transplant had an increased risk of graft loss with (HR: 2.82 [95% CI: 1.11–7.44], p = 0.015) or without death censoring (HR: 2.31 [95% CI: 1.06–5.04], p = 0.035). Low creatinine clearance (HR: 4.72 [95% CI: 1.63–13.69], p = 0.004), high urinary protein excretion (HR: 3.21 [95% CI: 1.27–8.18], p = 0.014) and delayed graft function (DGF) (HR: 2.621 [95% CI: 1.07–6.39], p = 0.036) were also independent risk factors for graft loss. MS did not independently predict graft loss, partly due to significant interactions with low‐grade inflammation. We conclude that post‐transplant weight gain significantly reduces graft survival.