A ‘Weight-Listing’ Paradox for Candidates of Renal Transplantation?
Article first published online: 6 DEC 2006
American Journal of Transplantation
Volume 7, Issue 3, pages 550–559, March 2007
How to Cite
Schold, J.D., Srinivas, T.R., Guerra, G., Reed, A.I., Johnson, R.J., Weiner, I.D., Oberbauer, R., Harman, J.S., Hemming, A.W. and Meier-Kriesche, H.U. (2007), A ‘Weight-Listing’ Paradox for Candidates of Renal Transplantation?. American Journal of Transplantation, 7: 550–559. doi: 10.1111/j.1600-6143.2006.01629.x
- Issue published online: 6 DEC 2006
- Article first published online: 6 DEC 2006
- Received 21 July 2006, revised 11 September 2006 and accepted for publication 10 October 2006
- kidney transplantation;
- patient survival;
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.