Obesity Should Not Rule Out Kidney Transplantation

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In a study, kidney transplant recipients with a BMI (in kg/m2) higher than 35 have graft and patient outcomes similar to those with a BMI less than 35 but higher than 30.
In a study, kidney transplant recipients with a BMI (in kg/m2) higher than 35 have graft and patient outcomes similar to those with a BMI less than 35 but higher than 30.
The following article is part of conference coverage from Kidney Week 2018 in San Diego hosted by the American Society of Nephrology. Renal & Urology News staff will be reporting live on medical studies conducted by nephrologists and other specialists who are tops in their field in acute kidney injury, chronic kidney disease, dialysis, transplantation, and more. Check back for the latest news from Kidney Week 2018.

SAN DIEGO—Prospective kidney transplant recipients should not necessarily be denied a kidney because they have a high body mass index (BMI), new study findings presented at the American Society of Nephrology's Kidney Week 2018 conference suggest.

In a study using a paired-kidney model in which kidneys from the same deceased donor were transplanted into 2 recipients in different BMI groups, recipients with a BMI (in kg/m2) greater than 35 and those with a BMI of 30 to 35 had similar long-term graft and patient outcomes, regardless of delayed graft function, Bhavna Chopra, MD, of Allegheny General Hospital in Pittsburgh, and colleagues reported.

“Non-inferior patient outcomes among patients with a BMI above 35 could reflect careful pre-transplant selection among very obese candidates or a survival advantage that is similar to that of the obese dialysis patients,” Dr Chopra told attendees. “Hence, potential kidney transplant recipients should not be excluded from renal transplantation solely on the basis of obesity.”

The data “support a more favorable consideration of obese patients for kidney transplantation and suggest that the use of a BMI cut off between 35 and 40, while common, is arbitrary and unfounded,” she said.

The study included 39,334 recipient pairs. Of these, 4949 had a BMI greater than 35. The median follow-up was 43.9 months. Compared with recipients who had a BMI greater than 35, those with a BMI of 18 to 25 had significant 59% decreased odds of delayed graft failure and 23% decreased odds of death-censored graft failure, but were not more likely to die. Recipients with a BMI of 25 to 30 had significant 16% decreased odds of death-censored graft failure.

Higher rates of death-censored graft failure among all patients with a BMI above 30 may reflect inflammation, hyperfiltration, increased postoperative complications, or sub-therapeutic immunosuppression, Dr Chopra said.


Visit Renal & Urology News' conference section for continuous coverage from Kidney Week 2018.

Reference

Chopra B, McGill RL, Josephson MA, et al. Impact of obesity on kidney transplant outcomes: A paired-kidney analysis. Presented at the American Society of Nephrology's Kidney Week 2018 conference in San Diego, Oct. 23-28. Abstract TH-OR121.

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