Journal article
Obesity and Kidney Transplant Candidates: How Big Is Too Big for Transplantation?
American journal of nephrology, Vol.36(6), pp.575-586
01/01/2012
DOI: 10.1159/000345476
PMID: 23221167
Abstract
Obesity impacts many inter-related, and sometimes conflicting, considerations for transplant practice. In this article, we describe an approach for applying available data on the importance of body composition to the kidney transplant population that separates implications for candidate selection, risk stratification among selected candidates, and interventions to optimize health of the individual. Transplant recipients with obesity defined by elevated body mass index (BMI) have been shown in many (but not all) studies to experience an array of adverse outcomes more commonly than normal-weight transplant recipients, including wound infections, delayed graft function, graft failure, cardiac disease, and increased costs. However, current studies have not defined limits of body composition that preclude clinical benefit from transplantation compared with long-term dialysis in patients who have passed a transplant evaluation. Formal cost-effectiveness studies are needed to determine if payers and society should be compensating centers for clinical and financial risks of transplanting obese end-stage renal disease patients. Recent studies also demonstrate the limitations of BMI alone as a measure of adiposity, and further research should be pursued to define practical measures of body composition that refine accuracy for outcomes prediction. Regarding individual management, observational registry studies have not found beneficial associations of pretransplant weight loss with patient or graft survival. However, association studies cannot distinguish purposeful from unintentional weight loss as a result of illness and comorbidity. Prospective evaluations of the impact of targeted risk modification efforts in this population including dietary changes, monitored exercise programs, and bariatric surgery are urgently needed. Copyright (C) 2012 S. Karger AG, Basel
Details
- Title: Subtitle
- Obesity and Kidney Transplant Candidates: How Big Is Too Big for Transplantation?
- Creators
- Krista L. Lentine - Saint Louis UniversityRowena Delos Santos - Washington University in St. Louis School of MedicineDavid Axelrod - Dartmouth CollegeMark A. Schnitzler - Saint Louis UniversityDaniel C. Brennan - Washington University in St. LouisJanet E. Tuttle-Newhall - Washington University in St. Louis School of Medicine
- Resource Type
- Journal article
- Publication Details
- American journal of nephrology, Vol.36(6), pp.575-586
- Publisher
- Karger
- DOI
- 10.1159/000345476
- PMID
- 23221167
- ISSN
- 0250-8095
- eISSN
- 1421-9670
- Number of pages
- 12
- Language
- English
- Date published
- 01/01/2012
- Academic Unit
- Surgery
- Record Identifier
- 9984322807702771
Metrics
15 Record Views