Association Between Weight Loss Before Deceased Donor Kidney Transplantation and Posttransplantation Outcomes

Tackling the weight list problem

“…Additionally, there is the concern that bariatric surgery and its concomitant weight loss can lead to significant protein malnutrition and frailty, which are well‐documented to lead to worse wait‐list and posttransplant outcomes. Indeed, weight loss of ≥10% prior to deceased donor kidney transplant was associated with an 11% higher hazard of graft loss and 18% higher hazard of death, though it is unclear whether these associations hold true in the case of intentional weight loss . Finally, and perhaps most tantalizing, is the possibility that dramatic weight loss can halt progression of CKD, as the authors noted in a subanalysis of CKD stage 3A/3B patients and as has been suggested in other studies.…”

Abdominal Organ Transplantation: Noteworthy Literature in 2019

“…� Improving access to transplantation with bariatric surgery: Kim et al 26 In this observational retrospective study of 41 patients who underwent LSG prior to KT, patients had sustained long-term weight loss, relatively few complications, and significant improvement in hypertension, insulin use, and no cases of new-onset diabetes after transplantation. � Frailty: Harhay et al 30 This review of the OPTN data revealed that DDKT recipients with �10% pretransplant weight loss are at increased risk for longer hospital length of stay, higher all-cause graft loss, and higher mortality. � Risk stratification: Wu et al 40 In this prospective cohort study of 2100 KT recipients, peripheral vascular disease, obesity, heart failure, cerebrovascular disease, and chronic liver disease were risk factors for graft loss and mortality in DDKT recipients.…”

“…Several publications in 2019 examined frailty as a risk factor for poor outcomes after KT. [30][31][32][33] Whether weight loss, a hallmark of frailty, portends a higher risk of adverse outcomes among kidney recipients remains a topic of debate. Examination of the OPTN database of 94 465 recipients from 2004 to 2014 by Harhay et al revealed that DDKT recipients with �10% pretransplant weight loss are at increased risk for adverse outcomes such as longer hospital length of stay, higher all-cause graft loss, and higher mortality, and may benefit from augmented posttransplant support.…”

“…Examination of the OPTN database of 94 465 recipients from 2004 to 2014 by Harhay et al revealed that DDKT recipients with �10% pretransplant weight loss are at increased risk for adverse outcomes such as longer hospital length of stay, higher all-cause graft loss, and higher mortality, and may benefit from augmented posttransplant support. 30 Recurrent falls, another marker of frailty, was assessed in a 2-center cohort study of >4200 patients, which found that 6.5% of KT candidates and 5.1% of recipients experienced recurrent falls, which were also associated with adverse pre-and post-KT outcomes such as graft loss and mortality. 31 Haugen et al assessed 7078 KT candidates from 2009 to 2018 and found that 21% were frail.…”

Obesity affects graft function but not graft loss in kidney transplant recipients

“…4 However, there is an argument against weight loss while on the waiting list for deceased-donor kidney transplantation although obesity negatively affects posttransplant outcomes. 5 One important consideration is that the muscle mass and protein storage levels are critical outcome determinants in dialysed patients;…”