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Obesity has generally been thought to increase the risk of operative mortality and postoperative complications in surgical patients. No data examining obesity as a factor in cadaveric renal transplantation were available. We therefore matched obese patients undergoing cadaveric renal transplantation with nonobese control patients and retrospectively analyzed mortality, morbidity, and graft survival in each group. Patients were matched for age, sex, diabetes mellitus, PRA, graft number, cardiovascular disease, date of transplantation, and posttransplant immunosuppression. There were significant differences found in mortality (11% in obese vs. 2% in nonobese patients, P≤0.01), immediate graft function (38% in obese vs. 64% in nonobese patients, P≤0.01), 1-year graft survival (66% in obese vs. 84% in nonobese patients, P≤0.05), and postoperative complications. Wound complications (20% vs. 2%, P≤0.01), intensive-care-unit admissions (10% vs. 2%, P≤0.01), reintubations (16% vs. 2%, P≤0.03), and new-onset diabetes (12% vs. 0%, P≤0.02) were all significantly more common in the obese group. These results suggest that an attempt at significant weight reduction is indicated in obese patients prior to renal transplantation.