Differential Association of Body Mass Index with Access to Kidney Transplantation in Men and Women

Abstract

Background and objectives Obese patients encounter barriers to medical care not encountered by lean patients, and inequities in access to care among obese patients may vary by sex. This study aimed to determine the association of body mass index (BMI) with access to kidney transplantation in men and women.Design, setting, participants, & measurements In this retrospective analysis of 702,456 incident ESRD patients aged 18-70 years (captured in the US Renal Data System between 1995 and 2007), multivariate time-to-event analyses were used to determine the association of BMI with likelihood of transplantation from any donor source, transplantation from a living donor, and transplantation from a deceased donor, as well the individual steps in obtaining a deceased donor transplant (activation to the waiting list, and transplantation after wait-listing).Results Among women, a BMI$25.0 kg/m 2 was associated with a lower likelihood of transplantation from any donor source (hazard ratio [HR], 0.75; 95% confidence interval [95% CI], 0.73 to 0.77), transplantation from a living donor (HR, 0.75; 95% CI, 0.72 to 0.77), and transplantation from a deceased donor (HR, 0.74; 95% CI, 0.72 to 0.77). By contrast, among men, a BMI of 25.0-34.9 kg/m 2 was associated with a higher likelihood of the outcomes of transplantation from any donor source (HR, 1.08; 95% CI, 1.06 to 1.11), transplantation from a living donor (HR, 1.18; 95% CI, 1.13 to 1.22), and transplantation from a deceased donor (HR, 1.05; 95% CI, 1.02 to 1.07). Among men, the level beyond which BMI was associated with a lower likelihood of transplantation from any donor source or a living donor was $40.0 kg/m 2 , and $35.0 kg/m 2 in the case of deceased donor transplantation. ConclusionsThe association of BMI with access to transplantation varies between men and women. The reasons for this difference should be further studied.Clin J Am Soc Nephrol 9: 951-959, 2014.

Impact of panniculectomy on transplant candidacy of obese patients with chronic kidney disease declined for kidney transplantation because of a high-risk abdominal panniculus: A pilot study

“…A recent analysis of the US Renal Data System database that focused on obese patients with CKD showed that obese women have a lesser probability of receiving a kidney transplant than obese men. 9 This access disparity for obese women is further compounded by their greater likelihood of developing a highrisk panniculus, as also suggested by our study cohort's sex distribution.…”

“…This issue is even more relevant for patients with CKD, because prevalence of obesity in that group is much greater than in the general population to begin with, and because obesity in general has been shown to impair access to kidney transplantation. [7][8][9] At our transplant center, we attempted to provide patients with a high-risk panniculus with a realistic chance for a renal transplant and its cardiovascular morbidity-and mortality-lowering benefits. We developed a novel clinical pathway in collaboration with our plastic surgeons by devising a 2-stage approach that included panniculectomy followed by a transplant.…”

“…This novel approach is particularly relevant for CKD patients as they are disproportionately affected by the obesity epidemic and because CKD patients that are obese already face multiple other barriers to transplantation. [7][8][9] …”

Mortality in Elderly Waiting-List Patients Versus Age-Matched Kidney Transplant Recipients: Where is the Risk?

“…To further complicate this alarming situation, comorbidities can progress throughout ESRD [33], including those waitlisted for KT. Finally, other barriers to accessing KT, such as socio-demographic factors (obesity, female patients, patients who live in rural areas or far from transplant centers, among others) could increase the time on the WL and favor the onset or impairment of non-desirable comorbidities while still on the WL, leading to a higher mortality [19, 34-36]. However, there may be a high overlap in the risk profile and life-expectancy of patients waitlisted for KT and those who are not [24], suggesting that accurate assessment of the risk of death should be performed in order to prioritize or properly assign a KT.…”

Living Donor Kidney Transplantation

“…Gill et al (55) recently found that overweight and obese women are significantly less likely to receive LDKT compared with overweight and obese men. Despite these notable barriers, there does not appear to be a sex disparity in LDKT because women comprise 40% of the candidates on the transplant waiting list and are recipients of 39% of all kidney transplants annually (1).…”