Kidney transplantation in the morbidly obese: complicated but still better than dialysis

Abstract

Obese patients are denied renal transplantation in many centers. We report results regarding obesity from a new transplant program (1999 through 2007). Six hundred and forty-two patients were transplanted: 439 patients with BMI < 30 (Group 1), 109 patients with BMI 30.1-34.9 (Group 2), and 89 patients with BMI > 35 (Group 3). Follow-up was at least one yr. Medical and surgical management was performed by the same team throughout the study period. There were no demographic differences between groups except for increased diabetes in Groups 2 and 3. Actuarial graft and patient survivals were not statistically different between groups. Group 3 patients had numerical trends toward more delayed graft function and lower graft survivals but these did not reach statistical significance. Biopsy-proven rejections did not differ between groups. Wound infections were statistically significant in Groups 2 and 3 compared to Group 1 (p < 0.01). Despite increased wound infection rates with increased BMI, transplanting patients with morbid obesity results in better survival for individual patients than dialysis. Thus, there is no a priori ethical reason for treating obese ESRD patients differently from those with other comorbidities.

Obesity and Body Composition for Transplant Wait-List Candidacy—Challenging or Maintaining the BMI Limits?

“…At least two recent studies have attempted to address this question. 8,9 Glanton et al . assembled a cohort of 7,521 patients who started dialysis between 1995 and 1999 and were eventually placed on a kidney transplant waiting list.…”

The Impact of Recipient Obesity on Outcomes After Renal Transplantation

“…Several relatively small studies have demonstrated no significant adverse effect of recipient obesity on patient and graft survival. [9][10][11] On the other hand, larger studies of registry data have demonstrated significantly worse survival outcomes for obese recipients, including a study of more than 50,000 recipients in the US Renal Data System performed by Meier-Kreische 12 and a study of more than 27,000 recipients in the United Network for Organ Sharing database performed by Gore and colleagues. 13 Both of these studies, however, examined patients undergoing transplantation before 2000, so the results may be different in the modern era of more powerful immunosuppression and improved overall patient management.…”

The impact of morbid obesity on resource utilization after renal transplantation

“…Previous studies have found RT to have a significantly lesser mortality rate compared with lifelong hemodialysis among this population. 15 Therefore, despite greater resource utilization, RT should not be withheld based on BMI. With respect to poorer fiscal outcomes, two adjustments may be made to improve current policy.…”

“…Both concluded that while RT had greater complication rates, transplantation was more favorable than lifelong dialysis. 15,16 …”