Obesity Impacts Access to Kidney Transplantation

Segev, Dorry L.; Simpkins, Christopher E.; Thompson, Richard E.; Locke, Jayme E.; Warren, Daniel; Montgomery, Robert A.

doi:10.1681/asn.2007050610

Cited by 226 publications

(176 citation statements)

References 24 publications

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“…A recent study of adults with ESRD also found that obese patients were less likely to receive kidney transplants, particularly from living donors. 26 Given the known correlation between children's and parents' BMIs, a potential explanation for the low rate of transplantation among obese children is that their parents are less likely to be accepted as living donors. 14 Because parents account for almost 80% of living kidney donors for children, any limitation in parental donation could have an important effect.…”

Section: Discussionmentioning

confidence: 99%

Association of Body Mass Index with Patient-Centered Outcomes in Children with ESRD

Ku¹,

Glidden

Hsu³

et al. 2016

Journal of the American Society of Nephrology

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Obesity is associated with less access to transplantation among adults with ESRD. To examine the association between body mass index at ESRD onset and survival and transplantation in children, we performed a retrospective analysis of children ages 2-19 years old beginning RRT from 1995 to 2011 using the US Renal Data System. Among 13,172 children, prevalence of obesity increased from 14% to 18%, whereas prevalence of underweight decreased from 12% to 9% during this period. Over a median follow-up of 7.0 years, 10,004 children had at least one kidney transplant, and 1675 deaths occurred. Risk of death was higher in obese (hazard ratio [HR], 1.17; 95% confidence interval [95% CI], 1.03 to 1.32) and underweight (HR, 1.26; 95% CI, 1.09 to 1.47) children than children with normal body mass indices. Obese and underweight children were less likely to receive a kidney transplant (HR, 0.92; 95% CI, 0.87 to 0.97; HR, 0.83; 95% CI, 0.78 to 0.89, respectively). Obese children had lower odds of receiving a living donor transplant (odds ratio, 0.85; 95% CI, 0.74 to 0.98) if the transplant occurred within 18 months of ESRD onset. Adjustment for transplant in a timedependent Cox model attenuated the higher risk of death in obese but not underweight children (HR, 1.09; 95% CI, 0.96 to 1.24). Lower rates of kidney transplantation may, therefore, mediate the higher risk of death in obese children with ESRD. The increasing prevalence of obesity among children starting RRT may impede kidney transplantation, especially from living donors.

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Section: Discussionmentioning

confidence: 99%

Association of Body Mass Index with Patient-Centered Outcomes in Children with ESRD

Ku¹,

Glidden

Hsu³

et al. 2016

Journal of the American Society of Nephrology

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“…Rates of listing for a deceaseddonor transplant and progression on the waiting list vary significantly by race/ethnicity, body mass index, socioeconomic factors, and geographic location (10,11). Numerous reports demonstrated that patients who are proactive and are able to navigate the processes involved to receive a transplant have significantly improved prognoses (12)(13)(14).…”

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confidence: 99%

Half of Kidney Transplant Candidates Who Are Older than 60 Years Now Placed on the Waiting List Will Die before Receiving a Deceased-Donor Transplant

Schold

Srinivas

Sehgal

et al. 2009

Clinical Journal of the American Society of Nephrology

184

130

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Background and objectives: Waiting times to deceased-donor transplantation (DDTx) have significantly increased in the past decade. This trend particularly affects older candidates given a high mortality rate on dialysis.Design, setting, participants, & measurements: We conducted a retrospective analysis from the national Scientific Registry of Transplant Recipients database that included 54,669 candidates who were older than 60 yr and listed in the United States for a solitary kidney transplant from 1995 through 2007. Using survival models, we estimated time to DDTx and mortality after candidate listing with and without patients initially listed as temporarily inactive (status 7).Results: Almost half (46%) of candidates who were older than 60 yr and listed in 2006 through 2007 are projected to die before receiving a DDTx. This proportion varied by individual characteristics: Diabetes (61%), age >70 yr (52%), black (62%), blood types O (60%) and B (71%), highly sensitized (68%), and on dialysis at listing (53%). Marked variation also existed by United Network for Organ Sharing region (6 to 81%). The overall projected proportion was reduced to 35% excluding patients who initially were listed as status 7.Conclusions: These data highlight the prominent and growing challenge facing the field of kidney transplantation. Older candidates are now at significant risk for not surviving the interval in which a deceased-donor transplant would become available. Importantly, this risk is variable within this population, and specific information should be disseminated to patients and caregivers to facilitate informed decision-making and potential incentives to seek living donors.

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“…In the adult population, there has been considerable debate about the access to transplantation according to BMI criteria, and in many national guidelines and centres specific policy limits (such as a BMI of 35 kg/m 2 ) are in place in an attempt to minimise the post-operative morbidity and mortality [11][12][13]. As yet, this does not appear to have translated into the paediatric setting and, indeed, it would be rather difficult to justify such a policy.…”

Section: Access To Transplantationmentioning

confidence: 99%

Paediatric obesity and renal transplantation: current challenges and solutions

Terrace

Oniscu

2015

Pediatr Nephrol

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The increased incidence of obesity in the paediatric population poses significant challenges to renal transplantation. Whilst the body mass index appears to be widely used as a measure of obesity in adults, there are no standardised definitions in the paediatric population, making comparative analyses difficult. In the paediatric transplant population, obesity is associated with an increased incidence of surgical complications, diabetes, hyperlipidaemia and cardiovascular morbidity, leading to diminished graft function and impacting patient and graft survival. Management of obesity in renal transplantation requires multiple interventions starting with lifestyle and behavioural modification combined with medical and possibly surgical therapies, representing a unique challenge in the childhood setting. In this review we discuss the current challenges of obesity and potential solutions in the setting of paediatric transplantation.

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Obesity Impacts Access to Kidney Transplantation

Cited by 226 publications

References 24 publications

Association of Body Mass Index with Patient-Centered Outcomes in Children with ESRD

Association of Body Mass Index with Patient-Centered Outcomes in Children with ESRD

Half of Kidney Transplant Candidates Who Are Older than 60 Years Now Placed on the Waiting List Will Die before Receiving a Deceased-Donor Transplant

Paediatric obesity and renal transplantation: current challenges and solutions

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