Effects of body mass index on kidney transplant outcomes are significantly modified by patient characteristics

Schold, Jesse D.; Augustine, Joshua J.; Huml, Anne M.; Fatica, Richard; Nurko, Samuel; Wee, Alvin; Poggio, Emilio D.

doi:10.1111/ajt.16196

Cited by 28 publications

(27 citation statements)

References 43 publications

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“…The BMI criterion for transplantation or donor status may be limiting the number of Māori who are both receiving and donating a kidney. International evidence indicates that based on survival rates, higher body mass alone should not be a barrier for kidney transplantation [ 28 ] and that BMI thresholds should be significantly modified by patients’ characteristics and careful risk stratification [ 29 ]. Previous research in Aotearoa New Zealand has shown that ethnicity-specific criteria would provide more accurate measures of surgical and transplantation risk [ 30 ], as universal BMI categories fail to account for ethnic differences in fat distribution, muscularity, bone mineral mass, and leg length [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

“We Need a System that’s Not Designed to Fail Māori”: Experiences of Racism Related to Kidney Transplantation in Aotearoa New Zealand

Walker

Abel

Palmer

et al. 2022

J. Racial and Ethnic Health Disparities

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Background Reported experiences of racism in Aotearoa New Zealand are consistently associated with negative measures of health, self-rated health, life satisfaction, and reduced access to high-quality healthcare with subsequent poor health outcomes. In this paper, we report on perceptions and experiences of prejudice and racism by Indigenous Māori with kidney disease and their family members and donors who took part in a wider study about experiences of kidney transplantation. Methods We conducted semi-structured interviews with 40 Māori between September and December 2020. Participants included those with kidney disease who had considered, were being worked up for, or who had already received a kidney transplant as well as family members and potential or previous donors. We examined the data for experiences of racism using a theoretical framework for racism on three levels: institutionalised racism, personally mediated racism, and internalised racism. Results We identified subthemes at each level of racism: institutional (excluded and devalued by health system; disease stigmatization; discriminatory body weight criteria, lack of power), personally mediated (experiencing racial profiling; explicit racism), and internalized racism (shame and unworthiness to receive a transplant). Conclusions The wide-reaching experiences and perceptions of racism described by participants with kidney disease and their families in this research point to an unfair health system and suggest that racism may be contributing to kidney transplantation inequity in Aotearoa New Zealand. Addressing racism at all levels is imperative if we are to address inequitable outcomes for Māori requiring kidney transplantation. Supplementary Information The online version contains supplementary material available at 10.1007/s40615-021-01212-3.

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Section: Discussionmentioning

confidence: 99%

“We Need a System that’s Not Designed to Fail Māori”: Experiences of Racism Related to Kidney Transplantation in Aotearoa New Zealand

Walker

Abel

Palmer

et al. 2022

J. Racial and Ethnic Health Disparities

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“…However, in terms of graft loss and mortality, BMI has been reported to interact with various factors (recipient age, race/ethnicity, sex, and primary renal disease) of recipients. The authors emphasized the importance of personalized risk stratification rather than predicting recipient risk based on absolute BMI alone [ 26 ]. Accordingly, our study focused on the presensitization status among recipient factors, and the results showed a significant interaction between recipient BMI and presensitization status, which was an important finding.…”

Section: Discussionmentioning

confidence: 99%

Impact of high body mass index on allograft outcomes in kidney transplant recipients with presensitization to human leukocyte antigen

Park

Lee

et al. 2021

Kidney Res Clin Pract

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Background: This study aimed to investigate whether high body mass index (BMI) and presensitization to human leukocyte antigen (HLA) in kidney transplant recipients (KTRs) affected allograft outcomes. Methods: From January 2010 to December 2018, 1,290 kidney transplantations (KTs) were performed at the Seoul St Mary's Hospital. Of these, 682 cases of ABO-compatible living donor KT patients were enrolled. They were divided into four groups (low BMI-non-sensitized, high BMI-non-sensitized, low BMI-sensitized, and high BMI-sensitized) according to the median BMI value (22.7 kg/m 2 ) and HLA presensitization status (anti-HLA antibody mean fluorescence intensity > 3,000). Short-term and long-term allograft outcomes were compared between groups. Results: In the high BMI-sensitized group, the decline in allograft function was higher than that in the other three groups. Death-censored graft loss (DCGL) rates were highest in the high BMI-sensitized group (4 of 21 [19.0%], p = 0.04). In the multivariable Cox regression hazard regression model analysis, the hazard ratio (HR) for DCGL was intensified when high BMI and presensitization statuses were combined (HR, 3.75; p = 0.03); these statuses significantly interacted with each other (p-value for interaction = 0.008).

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“…Many studies have demonstrated that, similarly, graft survival in obese patients is inferior[ 20 , 21 , 55 , 58 , 59 ], and this pattern follows a U-shaped distribution, as patients with BMI values either lower or higher than the normal range (either ≤ 20 or ≥ 26 kg/m 2 ) have worse posttransplant outcomes[ 58 , 60 ]. Moreover, significant posttransplant weight gain or weight loss (> 5%) has been associated with decreased patient survival[ 29 , 54 , 61 ].…”

Section: Obesity and Kidney Transplantationmentioning

confidence: 99%

“…However, the effect of BMI on posttransplant outcomes may vary by patient characteristics. In their analysis among 296807 adult kidney transplant recipients from the Scientific Registry of Transplant Recipients, Schold et al [ 60 ] demonstrated that BMI follows a “J-Shaped” risk profile with elevated risks for overall graft loss with low BMI and obesity. Moreover, the risk of graft loss associated with BMI is strictly dependent on the patients’ characteristics: Low BMI was a relatively higher risk for older recipients (> 60 years) and males but not for younger patients, while high BMI was associated with an elevated risk for Caucasians and attenuated risk among African Americans and people with type II diabetes.…”

Section: Obesity and Kidney Transplantationmentioning

confidence: 99%

Obesity and bariatric surgery in kidney transplantation: A clinical review

Veroux

Mattone

Cavallo

et al. 2021

WJD

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Obesity is increasing worldwide, and this has major implications in the setting of kidney transplantation. Patients with obesity may have limited access to transplantation and increased posttransplant morbidity and mortality. Most transplant centers incorporate interventions aiming to target obesity in kidney transplant candidates, including dietary education and lifestyle modifications. For those failing nutritional restriction and medical therapy, the use of bariatric surgery may increase the transplant candidacy of patients with obesity and end-stage renal disease (ESRD) and may potentially improve the immediate and late outcomes. Bariatric surgery in ESRD patients is associated with weight loss ranging from 29.8% to 72.8% excess weight loss, with reported mortality and morbidity rates of 2% and 7%, respectively. The most commonly performed bariatric surgical procedures in patients with ESRD and in transplant patients are laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass. However, the correct timing of bariatric surgery and the ideal type of surgery have yet to be determined, although pretransplant LSG seems to be associated with an acceptable risk-benefit profile. We review the impact of obesity on kidney transplant candidates and recipients and in potential living kidney donors, exploring the potential impact of bariatric surgery in addressing obesity in these populations, thereby potentially improving posttransplant outcomes.

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Effects of body mass index on kidney transplant outcomes are significantly modified by patient characteristics

Cited by 28 publications

References 43 publications

“We Need a System that’s Not Designed to Fail Māori”: Experiences of Racism Related to Kidney Transplantation in Aotearoa New Zealand

“We Need a System that’s Not Designed to Fail Māori”: Experiences of Racism Related to Kidney Transplantation in Aotearoa New Zealand

Impact of high body mass index on allograft outcomes in kidney transplant recipients with presensitization to human leukocyte antigen

Obesity and bariatric surgery in kidney transplantation: A clinical review

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