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Should we consider excessive weights in pediatric kidney transplant recepient candidates?: A systematic review and meta-analysis of kidney transplantation outcomes.

Muhammad Asykar Palinrungi·Syarif Syarif·Khoirul Kholis·Abdul Azis·Moh Anfasa Giffari Makkaraka·Ahmad Taufik Fadillah Zainal·Adrian Manuel Sutanto·Syakri Syahrir
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Abstract

INTRODUCTION: In adult populations, excess body weight has been associated with an increased risk of adverse clinical outcomes and mortality following kidney transplantation. In contrast, the influence of obesity on transplantation outcomes among pediatric populations is not yet fully understood. This study aimed to evaluate the association between pre-transplant excess weight and post-transplant outcomes in pediatric kidney transplant recipients. MATERIAL & METHODS: A systematic literature search was performed across PubMed, ScienceDirect, and the Cochrane Library, covering publications up to December 31, 2025. The quality of the included studies was evaluated using the ROBINS-E tool. Statistical analysis was conducted using Review Manager version 5.4. RESULTS: From a total of 1465 records screened, six studies that included 65,483 participants were selected in the meta-analysis. The results indicated that pre-transplant excess weight was significantly associated with an increased risk of acute rejection (OR = 1.09; P = 0.009), delayed graft function (OR = 1.17; P < 0.00001), 1-year graft failure (OR = 1.16; P = 0.0002), and 5-year graft failure (OR = 1.13; P = 0.009). Although 5-year mortality was also higher among recipients with excess weight, this association was not statistically significant (OR = 1.08; P = 0.11). CONCLUSION: Pediatric patients with pre-transplant excess weight had higher post-transplant odds of acute rejection, delayed graft function, and both 1-year and 5-year graft failure compared to those without excess weight. These findings highlight the importance of assessing and managing excess weight prior to kidney transplantation to help prevent adverse outcomes in the future.

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HumansKidney TransplantationChildGraft RejectionGraft SurvivalPediatric ObesityTreatment OutcomePostoperative ComplicationsKidney transplantationMeta-analysisObesityOverweightPediatricJournal ArticleSystematic ReviewMeta-AnalysisReview

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Muhammad Asykar Palinrungi, Syarif Syarif, Khoirul Kholis, Abdul Azis, Moh Anfasa Giffari Makkaraka, Ahmad Taufik Fadillah Zainal, Adrian Manuel Sutanto, Syakri Syahrir. 2026-05-12. Should we consider excessive weights in pediatric kidney transplant recepient candidates?: A systematic review and meta-analysis of kidney transplantation outcomes.. https://doi.org/10.1016/j.jpurol.2026.105999

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Child subjectHumans subjectJournal Article subjectJournal Article; Systematic Review; Meta-Analysis; Review resourceMeta-Analysis subjectObesity subjectOverweight subjectPediatric subjectPostoperative Complications subjectSystematic reviews study

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