OBESITY AS A BARRIER TO TRANSPLANTATION: INSIGHTS FROM AN AUSTRALIAN TRANSPLANT CENTRE
Dr Emily Yeung1, A/Prof William Mulley1,2, Prof Kevan Polkinghorne1,3,4, Prof John Kanellis1,2
1Department of Nephrology, Monash Medical Centre, Clayton, Australia, 2Centre for Inflammatory Diseases, Department of Medicine, Monash University, Clayton, Australia, 3Department of Epidemiology & Preventative Medicine, Monash University, Clayton, Australia, 4Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Australia
Aim: To evaluate the number of potential kidney transplant recipients not currently active on the waiting list due to excess weight.
Background: Fewer than 10% of overweight potential transplant candidates achieve the requisite weight loss for waitlisting. Few studies have investigated effective methods to achieve weight loss to improve eligibility.
Methods: Patients referred for kidney transplant work-up at Monash Health and inactive on the transplant waiting list as of May 3, 2022 at least in part due to weight were included and followed until February 5, 2024. Data was obtained from hospital records, OrganMatch, and the Australian and New Zealand Dialysis & Transplant Registry (ANZDATA).
Results: 105 potential recipients (59 men and 46 women) were identified. Mean age was 52.6 years. Most (72.4%) were receiving kidney replacement therapy (mean dialysis vintage 36.9 months). Mean BMI was 36.0. Mean excess weight was 11.4kg. In the previous 12 months, 65% of potential recipients lost, 30% gained, and 5% had no change in weight. Weight loss methods included dietary changes (64%), exercise (41%), medications (5%), and bariatric surgery (0.9%). At the end of the follow up period, 9 (8.6%) potential recipients had been made active on the transplant list, 7 (6.7%) had received a deceased donor renal transplant, 2 (1.9%) had received a living related renal transplant, and 3 (2.8%) had achieved target weight but remained inactive due to medical issues. The remaining 84 (80%) remained above target weight and inactive on the transplant waiting list.
Conclusions: A significant number of potential kidney transplant recipients are inactive on the transplant waiting list due to excess weight. While most achieved some weight loss, only 17.2% were listed or transplanted.