Journal article
A 'weight-listing' paradox for candidates of renal transplantation?
American journal of transplantation, Vol.7(3), pp.550-559
2007
DOI: 10.1111/j.1600-6143.2006.01629.x
PMID: 17173655
Abstract
Research suggests that end‐stage renal disease patients with elevated body mass index (BMI) have superior outcomes on dialysis. In contrast, low and high BMI patients represent the highest risk cohorts for kidney transplant recipients. The important question remains concerning how to manage transplant candidates given the potentially incommensurate impact of BMI by treatment modality. We conducted a retrospective analysis of waitlisted and transplanted patients in the United States from 1990 to 2003. We constructed Cox models to evaluate the effect of BMI on mortality of waitlisted candidates and identified risk factors for rapid weight change. We then assessed the impact of weight change during waitlisting on transplant outcomes. Decline in BMI on the waiting list was not protective for posttransplant mortality or graft loss across BMI strata. Substantial weight loss pretransplantation was associated with rapid gain posttransplantation. The highest risk for death was among listed patients with low BMI (13–20 kg/m2, adjusted hazard ratio = 1.47, p < 0.01). Approximately one‐third of candidates had a change in BMI category prior to transplantation. While observed declines in BMI may be volitional or markers of disease processes, there is no evidence that candidates have improved transplant outcomes attributable to weight loss. Prospective trials are needed to evaluate the efficacy of weight loss protocols for candidates of kidney transplantation.
Details
- Title: Subtitle
- A 'weight-listing' paradox for candidates of renal transplantation?
- Creators
- J. D SCHOLD - Department of Medicine, Management, and Policy, University of Florida, Gainesville, Florida, United StatesT. R SRINIVAS - Department of Medicine, Management, and Policy, University of Florida, Gainesville, Florida, United StatesG GUERRA - Department of Medicine, Management, and Policy, University of Florida, Gainesville, Florida, United StatesA. I REED - Department of Surgery, Management, and Policy, University of Florida, Gainesville, Florida, United StatesR. J JOHNSON - Department of Medicine, Management, and Policy, University of Florida, Gainesville, Florida, United StatesI. D WEINER - Department of Medicine, Management, and Policy, University of Florida, Gainesville, Florida, United StatesR OBERBAUER - Department of Medicine, KH Elisabethinen, Linz and Medical University, Vienna, AustriaJ. S HARMAN - Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, Florida, United StatesA. W HEMMING - Department of Surgery, Management, and Policy, University of Florida, Gainesville, Florida, United StatesH. U MEIER-KRIESCHE - Department of Medicine, Management, and Policy, University of Florida, Gainesville, Florida, United States
- Resource Type
- Journal article
- Publication Details
- American journal of transplantation, Vol.7(3), pp.550-559
- Publisher
- Blackwell; Oxford
- DOI
- 10.1111/j.1600-6143.2006.01629.x
- PMID
- 17173655
- ISSN
- 1600-6135
- eISSN
- 1600-6143
- Language
- English
- Date published
- 2007
- Academic Unit
- Accounting; Surgery
- Record Identifier
- 9984051546302771
Metrics
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