Incidence of Conversion to Active Waitlist Status Among Temporarily Inactive Obese Renal Transplant Candidates

Huang, Edmund; Shye, Michael; Elashoff, David; Mehrnia, Alireza; Bunnapradist, Suphamai

doi:10.1097/tp.0000000000000037

Cited by 32 publications

(25 citation statements)

References 27 publications

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“…,27 Future studies directly comparing mortality rates in patients with ESRD after bariatric surgery with the rates of those who did not undergo surgery, and those patients with ESRD who had weight loss without bariatric surgery, may provide more insight into the obesity paradox.In addition to improvement in comorbidities, SG also helped increase patient access to transplant. Our rate of deactivation from the list after initial activation in patients who had undergone SG was 22.5%, similar to findings in obese patients on the waitlist who had not undergone SG 28. Our rate of deactivation from the list after initial activation in patients who had undergone SG was 22.5%, similar to findings in obese patients on the waitlist who had not undergone SG 28.…”

supporting

confidence: 81%

Long-term outcomes in patients with obesity and renal disease after sleeve gastrectomy

Kassam

Mirza

Kim

et al. 2020

American Journal of Transplantation

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Morbid obesity is a barrier to kidney transplant in patients with end‐stage renal disease (ESRD). Laparoscopic sleeve gastrectomy (SG) is an increasingly considered intervention, but the safety and long‐term outcomes are uncertain. We reviewed prospectively collected data on patients with ESRD and chronic kidney disease (CKD) undergoing SG from 2011 to 2018. There were 198 patients with ESRD and 45 patients with CKD (stages 1‐4) who met National Institutes of Health guidelines for bariatric surgery and underwent SG; 72% and 48% achieved a body mass index of ≤ 40 and ≤ 35 kg/m2, respectively. The mean percentages of total weight loss and excess weight loss were 18.9 ± 10.8% and 38.2 ± 20.3%, respectively. SG reduced hypertension (85.8% vs 52.1%), decreased antihypertensive medication use (1.6 vs 1.0) (P < .01 each), and reduced incidence of diabetes (59.6% vs 32.5%, P < .01). Of the 71 patients with ESRD who achieved a body mass index of ≤ 40 kg/m2, 45 were waitlisted and received a kidney transplant, whereas 10 remain on the waitlist. Mortality rate after SG was 1.8 per 100 patient‐years, compared with 7.3 for non‐SG. Patients with stage 3a or 3b CKD exhibited improved glomerular filtration rate (43.5 vs 58.4 mL/min, P = .01). In conclusion, SG safely improves transplant candidacy while providing significant, sustainable effects on weight loss, reducing medical comorbidities, and possibly improving renal function in stage 3 patients.

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confidence: 81%

Long-term outcomes in patients with obesity and renal disease after sleeve gastrectomy

Kassam

Mirza

Kim

et al. 2020

American Journal of Transplantation

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“…Of note, these reports reveal epidemiological associations but do not prove causation nor do they differentiate between intentional and unintentional weight loss. On the other hand, the presence of obesity lowers the likelihood of being waitlisted for kidney transplantation (6,7). Intentional weight loss also offers the potential of improving quality of life and/or ameliorating illnesses as in the general populace, though studies demonstrating this are thus far lacking.…”

Section: Introductionmentioning

confidence: 99%

Personal Attitudes Toward Weight in Overweight and Obese US Hemodialysis Patients

Saeed

Janda

Tucker

et al. 2017

Journal of Renal Nutrition

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“…The study entry date was April 24, 2006, which was the first recorded date on the waitlist history file. As previously described, adult kidney transplant candidates (age ≥ 18) with a BMI ≥ 30 kg/m 2 and designated within 90 days of initial registration as status 7 due to a 'weight inappropriate for transplantation' were selected after excluding those with multiple listings, missing BMI, and clinically implausible BMI, defined as a BMI ≥ 65 kg/m 2 (n = 1,679) [18] . Among the 1,679 candidates, 328 received kidney transplants during the study period and comprised the exposure group (status 7).…”

Section: Study Populationmentioning

confidence: 99%

“…Using competing risks methods, we found that 49% of these candidates converted to active status within 6 years, with 61% of activated candidates receiving a transplant within 6 years of initial registration. Of the remaining candidates, 15% died, 21% delisted, and 15% continued in inactive status [18] .…”

Section: Introductionmentioning

confidence: 99%

“…We recently published waitlist outcomes among obese kidney transplant candidates designated temporarily inactive (status 7) on the United Network for Organ Sharing (UNOS) waitlist due to a weight considered inappropriate for transplant [18] . These recipients represent a population of candidates who underwent a period of waitlist inactivity for the purpose of weight loss.…”

Section: Introductionmentioning

confidence: 99%

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Pre-Transplant Weight Loss and Survival after Kidney Transplantation

Huang¹,

Bunnapradist²

2015

Am J Nephrol

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Background/Aims: We examined post-transplant survival among obese kidney candidates who were temporarily designated waitlist inactive (status 7) due to their weight. Methods: Using OPTN/United Network for Organ Sharing data, patient and graft survival of adult status 7 recipients with a registration body mass index (BMI) ≥30 kg/m² (n = 328) were compared to all others (controls; n = 74,066). Status 7 recipients were then matched to controls to assess whether pre-transplant weight loss was associated with a survival benefit. Results: Median BMI at registration (38 vs. 27 kg/m², p < 0.001) and transplant (36 vs. 27 kg/m², p < 0.001) and reduction in BMI while waitlisted (-5.0 vs. 0.0%, p < 0.001) were higher among status 7 than controls. Patient (status 7: 87.3%; control: 89.3%; p = 0.90) and graft survival (status 7: 82.9%; control: 81.6%; p = 0.75) were similar over 4 years. There was no association between status 7 and mortality (HR 0.96, 95% CI 0.59-1.57) or graft loss (HR 0.95, 95% CI 0.66-1.38) in the overall population nor between matched status 7 recipients and controls (patient survival: 86.0 vs. 87.5%, p = 0.20; graft survival: 82.6 vs. 77.2%, p = 0.61). Conclusion: Among obese status 7 kidney candidates previously considered too obese for transplant, patient and graft survival were comparable to the general transplant population. No difference in survival was observed with pre-transplant weight loss.

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Incidence of Conversion to Active Waitlist Status Among Temporarily Inactive Obese Renal Transplant Candidates

Abstract: Our findings indicate that half of obese status 7 candidates with a weight inappropriate for transplantation will not achieve active waitlist status. BMI at listing had a strong association with conversion to active status; comorbid factors and regional variation also impact activation.

Cited by 32 publications

References 27 publications

Long-term outcomes in patients with obesity and renal disease after sleeve gastrectomy

Long-term outcomes in patients with obesity and renal disease after sleeve gastrectomy

Personal Attitudes Toward Weight in Overweight and Obese US Hemodialysis Patients

Pre-Transplant Weight Loss and Survival after Kidney Transplantation

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