Donation approval among obese living kidney donor candidates: The impact of metabolic syndrome

Mustian, Margaux N.; Kumar, Vineeta; Hanaway, Michael J.; MacLennan, Paul A.; Shelton, Brittany A.; Reed, Rhiannon D.; Correya, Tanya; Grant, Raynesha; Carter, Alexis B.; Baker, Gavin; Patterson, Jelecia; Peoples, Markayla; Holden, Semaj; Orandi, Babak J.; Locke, Jayme E.

doi:10.1016/j.surg.2019.07.008

Cited by 8 publications

(5 citation statements)

References 25 publications

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“… 24 , 25 Although the exact criteria required to meet the definition of metabolic syndrome varies, 26 , 27 many centers go beyond BMI and take metabolic syndrome into account during evaluation. 28 Even when accounting for conditions, such as hypertension, high levels of triglycerides, and fasting blood glucose, there was no statistical significance in the odds of donors being required to lose weight predonation. This observation may reflect the paucity of data regarding the impact of metabolic dysfunction on postdonation outcomes.…”

Section: Discussionmentioning

confidence: 99%

Patient-Level and Center-Level Factors Associated with Required Predonation Weight Loss among Obese Living Kidney Donors

Perry,

McLeod,

Reed

et al. 2024

Kidney360

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Background: The proportion of overweight/mildly obese living kidney donors has increased in the past few decades, with significant center variation in the BMI of LKDs. The purpose of this study was to examine factors associated with required pre-donation weight loss among obese (body mass index, BMI, >30kg/m2) living kidney donors (OLKDs). Methods: This retrospective cohort study surveyed 1097 OLKDs (1979-2020) (mean BMI 33 kg/m2) about their donation experience. Bivariate analyses compared donor demographic and center characteristics by whether the donor reported pre-donation weight loss requirement. Generalized estimating equations (GEE) with logit link were employed to estimate marginal effects of patient and center-level factors. Multiple imputation using chained equations was implemented to account for missing values. Results: Of 1097 OLKDs surveyed, 340 (31.0%) reported pre-donation weight loss requirement. Donors with a pre-donation weight loss requirement had slightly higher pre-donation BMIs and donated in more recent years, at centers performing a lower percentage of living donor nephrectomies and with a lower median BMI. In multivariable logistic regression analysis, we observed transplant year (Odds Ratio (OR): 1.04 per year donation, 95%CI: 1.01-1.07, p=0.005), preoperative BMI (OR: 1.16, 95%CI: 1.05-1.28, p<0.01), preoperative hypertension (OR: 1.61, 95%CI: 1.08-2.40, p=0.02), and center percentage of living donor kidney transplants (OR: 0.99, 95%CI: 0.98-1.00, p=0.02) as significantly associated with a pre-donation weight loss requirement. The study found no differences in likelihood of pre-donation weight loss requirement by race, gender, or age, preoperative creatinine, preoperative metabolic dysfunction, or center level median BMI of living donors. Conclusions: These results suggest that both center and patient-level factors influence whether OLKDs are required to lose weight prior to donation. Future study is needed to determine whether pre-donation weight loss is associated with improved long-term post-donation outcomes.

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Section: Discussionmentioning

confidence: 99%

Patient-Level and Center-Level Factors Associated with Required Predonation Weight Loss among Obese Living Kidney Donors

Perry,

McLeod,

Reed

et al. 2024

Kidney360

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“…Also, in kidney transplant recipients, HTN has been shown to be a significant risk factor for the development of delayed graft function and even graft failure[ 37 ]. Mustian et al [ 38 ] analyzed the odds for causes of non-approval in LKD candidates in a single-center database between 2012 and 2017 and found out that donor HTN was associated with four-fold increase in odds of non-approval, with every 10-mm Hg increase in systolic blood pressure resulting in 30% increase odds of non-approval. Theoretically, the combination of HTN and obesity in LKD candidates carries significant short- and long-term risks and potential complications[ 39 ].…”

Section: Htn and Living Kidney Donationmentioning

confidence: 99%

Hypertension and obesity in living kidney donors

Mohamed¹,

Daoud²,

Quadri³

et al. 2021

WJT

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Over the past few decades, the shortage in the kidney donor pool as compared to the increasing number of candidates on the kidney transplant waitlist led to loosening of kidney donors’ acceptance criteria. Hypertension and obesity represent risk factors for chronic kidney disease, both in native kidneys and those in kidney transplant recipients. While great progress has been made in kidney transplantation from living donors to benefit the recipient survival and quality of life, progress has been slow to fully risk-characterize the donors. This review critically reassesses the current state of understanding regarding the risk of end-stage kidney disease in those donors with obesity, hypertension or both. Accurate risk assessment tools need to be developed urgently to fully understand the risk glomerular filtration rate compensation failure in the remaining kidney of the donors.

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“…The risk‐benefit balance for donors may change, especially with the expanded use of medically complex donors (e.g., those with obesity, older age, and other comorbidities) 11–17 . In addition, there are methodological concerns about existing studies related to the accuracy of reported risk for donors and their comparison to non‐donor controls, as the former tend to be inherently healthier than the latter, 18 thereby confounding the relationship between donation and subsequent adverse health outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…10 The risk-benefit balance for donors may change, especially with the expanded use of medically complex donors (e.g., those with obesity, older age, and other comorbidities). [11][12][13][14][15][16][17] In addition, there are methodological concerns about existing studies related to the accuracy of reported risk for donors and their comparison to nondonor controls, as the former tend to be inherently healthier than the latter, 18 thereby confounding the relationship between donation and subsequent adverse health outcomes. Long-term donor follow-up provides greater understanding of donation risks, allows for enhanced pre-donation counseling, and could facilitate early detection, intervention, and mitigation of adverse consequences to the donor.…”

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confidence: 99%

Donor‐reported barriers to living kidney donor follow‐up

Orandi

Reed

et al. 2022

Clinical Transplantation

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Background Despite regulations mandating follow‐up laboratory testing for living kidney donors, less than half of transplant centers are in compliance. We sought to understand barriers to follow‐up testing from the donors’ perspective. Methods We surveyed our center's living kidney donors. Binary logistic regression was used to assess factors associated with follow‐up testing completion. Results Of 185 living kidney donors, 110 (59.4%) participated. Among them, 82 (74.5%) completed 6‐month laboratory testing, 76 (69.1%) completed 12‐month testing, 68 (61.8%) completed both, and 21 (19.0%) completed neither. Six‐month testing completion was strongly associated with 12‐month testing completion (OR 9.74, 95%CI: 2.23‐42.50; p = .002). Those who disagreed with the statements, “Getting labs checked wasn't a priority for me,” (OR for completing 6‐month testing: 15.05, 95%CI: 3.70‐61.18; p < .001; OR for completing 12‐month testing: 5.85, 95%CI: 1.94‐17.63; p = .002); and, “I forgot to get labs drawn [until I was reminded]” (OR for completing 6‐month testing: 6.93, 95%CI: 1.59‐30.08; p = .01; OR for completing 12‐month testing: 6.55, 95%CI: 1.98‐21.63; p = .002) were more likely to complete testing. Conclusions To our knowledge, this is the only study providing perspective on donor insights regarding the need for follow‐up testing post donation. Interventions to influence living donor attitudes toward follow‐up testing may improve follow‐up.

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Donation approval among obese living kidney donor candidates: The impact of metabolic syndrome

Cited by 8 publications

References 25 publications

Patient-Level and Center-Level Factors Associated with Required Predonation Weight Loss among Obese Living Kidney Donors

Patient-Level and Center-Level Factors Associated with Required Predonation Weight Loss among Obese Living Kidney Donors

Hypertension and obesity in living kidney donors

Donor‐reported barriers to living kidney donor follow‐up

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