The Survival Benefit of Kidney Transplantation in Obese Patients

Gill, John S.; Lan, James H.; Dong, Jianghu; Rose, Caren; Hendren, Elizabeth; Johnston, Olwyn

doi:10.1111/ajt.12331

Cited by 175 publications

(130 citation statements)

References 24 publications

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“…There has been limited examination of the association of obesity with access to medical care among patients with ESRD. We recently reported that the survival benefit from transplantation compared with treatment with dialysis in most obese patients is similar to that among nonobese patients, and therefore obesity alone should not exclude patients from consideration of transplantation (7).…”

Section: Introductionmentioning

confidence: 99%

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

Gill

Hendren

Dong

et al. 2014

Clinical Journal of the American Society of Nephrology

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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.

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Section: Introductionmentioning

confidence: 99%

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

Gill

Hendren

Dong

et al. 2014

Clinical Journal of the American Society of Nephrology

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“…The survival benefit of renal transplantation over dialysis might be considered for these patients. Although studies performed over the past 2 decades report better clinical outcomes of kidney transplantation for mild obese patients, the survival advantage of transplantation over dialysis is still uncertain in these patients with morbid and extremely morbid obesity [30,31] . Fortunately, with the noted increase in the prevalence of obesity and extremely morbid obesity, some of the transplantation centers are currently accepting patients with higher BMI as potential candidates for renal transplantation.…”

Section: Renal Transplantation In Extremely Morbid Obese Patientsmentioning

confidence: 99%

Challenges Associated with Managing End-Stage Renal Disease in Extremely Morbid Obese Patients: Case Series and Literature Review

Turgut

Abdel‐Rahman

2017

Nephron

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Obesity has grown into an epidemic across the globe. Mirroring this growth in the number of obese individuals in the general population, the prevalence of obesity and extremely morbid obesity (body mass index >50 kg/m<sup>2</sup>) is similarly rising in patients with end-stage renal disease (ESRD). Obesity, and more so, extremely morbid obesity, creates additional challenges for clinicians aiming at providing the best treatment options to patients with ESRD. Although literature is available regarding renal replacement therapy (RRT) for obese patients, literature about challenges facing clinicians managing ESRD in the extremely obese patients is lacking. Furthermore, the optimal strategies and goals for managing these patients with ESRD are not well defined. To our knowledge, no study has been done evaluating RRT options available to extremely morbid obese patients and the challenges associated with these options. Here, we report a case series and discuss the potential challenges faced by extremely obese patients with ESRD requiring RRT.

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“…This benefit of transplantation compared with long-term dialysis holds among obese recipients as well. Previous studies have shown a 50% risk reduction in death for obese patients who receive a kidney transplant (4,5).…”

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confidence: 99%

BMI, Sex, and Access to Transplantation

Huml

Sehgal

2014

Clinical Journal of the American Society of Nephrology

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An astonishing one of every three Americans in the general population is now obese, defined as a body mass index (BMI)$30.0 kg/m 2 (1). Even more strikingly, one of every two American patients with ESRD is obese (2). What is the best treatment modality for such patients? Among patients with ESRD in general, kidney transplantation confers better survival and increased quality of life compared with long-term dialysis (3). This benefit of transplantation compared with long-term dialysis holds among obese recipients as well. Previous studies have shown a 50% risk reduction in death for obese patients who receive a kidney transplant (4,5).However, the outcomes of transplantation are worse among obese recipients than normal-weight recipients. Several studies found that higher BMI is independently associated with delayed graft function, inferior graft and patient survival, and increased rates of acute rejection and new-onset diabetes (6-9). For example, one study showed at least a 2-fold higher risk of acute rejection and of delayed graft function among obese patients (8).Obese patients with ESRD have less access to transplantation than do normal-weight patients. A recent national study found that wait-listed patients with a BMI$35.0 kg/m 2 were 24%-42% less likely to receive a transplant compared with patients with lower BMI. Moreover, the most obese wait-listed patients were 13%-23% more likely to be passed over when organ offers are made (10). The reasons for this reduced access are as yet unclear. Obesity is not an absolute contraindication to kidney transplantation, unlike active infection and malignancy. However, it is a relative contraindication at many centers, albeit often with subjective and loosely defined cutoffs.In this issue of CJASN, Gill and colleagues (11) evaluate access to kidney transplantation according to BMI and sex through a retrospective analysis of .700,000 patients with incident ESRD over 12 years using data from the US Renal Data System (USRDS). Outcomes included any transplant, living-donor transplant, deceased-donor transplant, and two steps to obtain a deceased-donor transplant (waiting list placement, transplantation following wait listing). The findings of this study confirm that both obesity and sex are barriers to getting a kidney transplant from any source. More important, the association of obesity with access to transplantation varies greatly by sex. Women with a BMI$25.0 kg/m 2 had a lower likelihood of getting a transplant than normal-weight women. However, men with a BMI of 25.0-34.9 kg/m 2 had a higher likelihood of getting a transplant than normal-weight men. It wasn't until BMI was $35.0 kg/m 2 that the likelihood of getting a transplant declined among men.Strengths of the study include the consistent findings for both living-and deceased-donor kidney transplants and the adjustment for many relevant confounders, including rural or urban residence, blood type, and sensitization. Because of the extremely large sample size studied, it is important to focus on the effect size rat...

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The Survival Benefit of Kidney Transplantation in Obese Patients

Cited by 175 publications

References 24 publications

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

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

Challenges Associated with Managing End-Stage Renal Disease in Extremely Morbid Obese Patients: Case Series and Literature Review

BMI, Sex, and Access to Transplantation

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