Meier-Kriesche et al. showed that both abnormally low and abnormally high BMI are risk factors for decreased patient and graft survival, independent of most of the known risk factors.3 On the other hand, other studies failed to show the impact of obesity on renal see more graft survival.4,5 A BMI of 30 kg/m2 has been used as a cut-off point for obesity in white subjects. According to the contemporary American Society of Transplantation guidelines, a goal weight BMI

of less than 30 kg/m2 is desirable prior to renal transplantation.6 However, there is now international consensus that this cut-off point is too high for the Asian general population in terms of cardiovascular consequences.7 In 2000, the World Health Organization Western Pacific Regional Office proposed a modified BMI cut-off value of 23 kg/m2 to define overweight and 25 kg/m2 to define obesity in Asian populations (Table 1).8 These cut-off values are also validated in our Chinese population.9 The data concerning the impact of BMI on graft outcome in Asian renal transplant recipients is scarce. Chow et al. showed that baseline BMI of 25 kg/m2 or more conferred a significantly higher risk of graft loss and doubling of serum creatinine.10 However, there is a lack of data showing whether overweight

(BMI ≥23 kg/m2) also results HIF inhibitor in an increased risk of mortality and morbidity in Asian renal transplant recipients. The aim of this study is to identify the relationships between different BMI cut-off values at time of transplantation and graft outcome in Asian renal transplant recipients. We will also examine different factors which can

predict graft survival. This was a single-centre retrospective cohort study which included all Chinese patients who received solitary living-related or deceased kidney transplantation from 1 July 1997 to 31 July 2005 in Queen Elizabeth Hospital, Hong Kong. Initially we analyzed two separate cohorts Megestrol Acetate of patients based on the BMI at the time of transplantation. For the purpose of validation, patients were categorized into a non-obese group (baseline BMI <25 kg/m2) and obese group (baseline BMI ≥25 kg/m2). Analysis was repeated using a lower BMI cut-off value and the patients were categorized into normal group (baseline BMI <23 kg/m2) and overweight group (baseline BMI ≥23 kg/m2). Further analysis was also carried out with patients categorized into four groups based on their BMI quartiles. Follow-up data were analyzed until 31 March 2008. Data including the demographic and clinical variables of transplantation were collected from patients’ records. BMI (in kg/m2) was ascertained at the time of kidney transplantation, at 1 and 5 years post-transplant. The primary end-point was overall graft survival, which was defined as the time from transplantation until death, return to dialysis or re-transplantation. Additionally, patient survival and death-censored graft survival were investigated.