Obesity as a barrier to living kidney donation: a center‐based analysis

Sachdeva, Mala; Sunday, Suzanne R.; Israel, Ezra; Varghese, Jeny; Rosen, Lisa; Bhaskaran, Madhu; Molmenti, Ernesto P.; Mattana, Joseph

doi:10.1111/ctr.12246

Cited by 22 publications

(12 citation statements)

References 15 publications

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“…This is obviously not representative for the population that is undergoing kidney transplantation and is experiencing renal IRI. Overweight, comorbidities, old age, gender and the use of medication can all interfere with the effects of studied methods to ameliorate renal IRI [ 112 , 113 ]. Another limitation of animal experiments may be the use of warm ischemia models to mimic transplantation induced IRI [ 30 , 31 , 71 , 74 ].…”

Section: Discussionmentioning

confidence: 99%

Improving the outcome of kidney transplantation by ameliorating renal ischemia reperfusion injury: lost in translation?

et al. 2016

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Kidney transplantation is the treatment of choice in patients with end stage renal disease. During kidney transplantation ischemia reperfusion injury (IRI) occurs, which is a risk factor for acute kidney injury, delayed graft function and acute and chronic rejection. Kidneys from living donors show a superior short- and long-term graft survival compared with deceased donors. However, the shortage of donor kidneys has resulted in expansion of the donor pool by using not only living- and brain death donors but also kidneys from donation after circulatory death and from extended criteria donors. These grafts are associated with an increased sensitivity to IRI and decreased graft outcome due to prolonged ischemia and donor comorbidity. Therefore, preventing or ameliorating IRI may improve graft survival. Animal experiments focus on understanding the mechanism behind IRI and try to find methods to minimize IRI either before, during or after ischemia. This review evaluates the different experimental strategies that have been investigated to prevent or ameliorate renal IRI. In addition, we review the current state of translation to the clinical setting. Experimental research has contributed to the development of strategies to prevent or ameliorate IRI, but promising results in animal studies have not yet been successfully translated to clinical use.

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Section: Discussionmentioning

confidence: 99%

Improving the outcome of kidney transplantation by ameliorating renal ischemia reperfusion injury: lost in translation?

et al. 2016

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“…This study also emphasises the need to address obesity in the potential donor population. 56 Ensuring potential donors know at the time a relative or friend is diagnosed with renal disease that a high BMI will prevent donation and offering weightloss support at this stage will not only improve the health of potential donors, but also increase the likelihood of them being suitable for donation if this is something they wish to pursue in the future. Engaging with weightloss in advance of a possible kidney donation will help clinicians assess if the weightloss is sustainable, and likely to be maintained after donation.…”

Section: Future Workmentioning

confidence: 99%

A multicenter cohort study of potential living kidney donors provides predictors of living kidney donation and non-donation

Bailey

Tomson

MacNeill

et al. 2017

Kidney International

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This multicenter prospective potential living kidney donor cohort study investigated which sociodemographic and other factors predict progression to living kidney donation or donor withdrawal as little is known on this topic. Therefore, we examined data on individuals undergoing living donor assessment at seven hospitals in the United Kingdom. Multivariable logistic regression was used to explore the relationships between donor and recipient characteristics and likelihood of kidney donation. A total of 805 individuals presented for directed donation to 498 intended recipients, of which 112 received a transplant from a living donor. Potential donors were less likely to donate if their intended recipient was female rather than male with an odds ratio of 0.60, a friend rather than relative 0.18, or had renal failure due to a systemic disease rather than another cause 0.41. The most socioeconomically deprived quintile was less likely to donate than the least 0.49, but the trend with deprivation was consistent with chance. Higher body mass index was associated with a lower likelihood of donation (odds ratio per each kg/m increase, 0.92). Younger potential donors (odds ratio per each year increase 0.97), those of nonwhite ethnicity 2.98, and friend donors 2.43 were more likely to withdraw from work-up. This is the first study in the United Kingdom of potential living kidney donors to describe predictors of non-donation. Qualitative work with individuals who withdraw might identify possible ways of supporting those who wish to donate but experience difficulties doing so.

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“…Morbid obesity is projected to have a significant impact on the number of suitable live donors available in the future [4][5][6]. Case reports of BS for a potential OLKD prior to donation have only been published two times to our knowledge but has likely been performed many more times [49,50].…”

Section: Discussionmentioning

confidence: 99%

“…Mandelbrot et al reported that of the transplant centers surveyed, 52% have a BMI cutoff of 35 kg/m 2 [4]. Others have suggested that 22% of potential live donors were ineligible due to high BMI [5]. Currently, more than one-third of adults in the United States are obese [6].…”

Section: Introductionmentioning

confidence: 99%

Bariatric surgery for obese live kidney donors: an analysis of risks and benefits

Brooks¹,

Mitro²,

DeLeonibus³

et al. 2017

Integr Obesity Diabetes

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Background: Obesity can be a barrier to live donor selection and there are reports of obese live kidney donors (OLKDs) undergoing bariatric surgery prior to donation. While this practice has potential promise, the risks associated with it are unclear. Thus, our aim was to evaluate the advantages and disadvantages of this practice.Design: Risks and benefits were ascertained from the literature. Analysis of costs and benefits was performed to provide objective data for each scenario.Results: Live kidney donation is associated with superior outcomes compared to deceased donation. However, live donors are at risk of complications that could be exacerbated by obesity. Higher donor body mass index (BMI) has been associated with inferior recipient outcomes. Bariatric surgery (BS) results in decreased mortality and can induce sustained weight loss. Our cost-benefit analysis revealed a benefit-to-cost ratio of 3.64 for BS prior to live donation by OLKDs. We found ratios of 3.19 and 0.97 for live donation with an obese donor and a deceased donor, respectively. Conclusions:Our results suggest that BS for an OLKD has the potential to increase the number of live donors and improve outcomes. However, more data is required; thus we recommend a registry of patients who have undergone both procedures.

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Obesity as a barrier to living kidney donation: a center‐based analysis

Abstract: Obesity may be a frequent barrier to living kidney donation, directly leading to exclusion as a potential kidney donor in about one in five instances. Successful weight loss leading to donation appears to be infrequent, suggesting need to address obesity in the donor population.

Cited by 22 publications

References 15 publications

Improving the outcome of kidney transplantation by ameliorating renal ischemia reperfusion injury: lost in translation?

Improving the outcome of kidney transplantation by ameliorating renal ischemia reperfusion injury: lost in translation?

A multicenter cohort study of potential living kidney donors provides predictors of living kidney donation and non-donation

Bariatric surgery for obese live kidney donors: an analysis of risks and benefits

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