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Study: Weight loss pre-transplant linked to greater mortality rate

Issue: December 2018

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SAN DIEGO — Losing 10% or more of body weight prior to a deceased donor transplant was associated with a greater mortality rate after the transplant, according to results presented at ASN Kidney Week 2018.

Weight loss prior to surgery can be made at the request of a transplant physician as criteria for getting waitlisted, said Meera Nair Harhay, MD, FASN, of the Drexel University Department of Medicine in Philadelphia. However, it is also a recognized component of frailty, “signaling vulnerability to health stressors,” Harhay said in her presentation. “Whether deceased donor kidney transplant (DDKT) recipients who lost weight before DDKT are at higher risk of adverse post-transplant outcomes is unknown.”

Researchers reviewed all DDKT recipients in the United States between Jan. 1, 2005 and Dec. 31, 2014 who were adults at wait-listing. They used unadjusted fractional polynomial methods and adjusted Cox proportional hazards models to examine the association of relative change in body weight pre-DDKT with post-DDKT mortality.

Among 96,938 DDKT recipients, there was a relationship (unadjusted) between relative pre-DDKT weight change and post-DDKT mortality, “with a steep increase in mortality among DDKT recipients who lost 10% or more of their listing body weight compared to those with no pre-DDKT weight change,” Harhay said during her presentation. Specifically, for recipients with similar allograft characteristics, waiting time and dialysis vintage who lost weight pre-transplant compared to recipients with weights at DDKT within 5% of their listing weights, recipients who lost 10% or more of their listing body weight before DDKT were 14% more likely to die post-DDKT (adjusted hazard ratio 1.14).

“Substantial weight loss before DDKT may indicate increased vulnerability after DDKT,” Harhay said. “Studies are needed to identify and modify unhealthy weight trajectories among DDKT candidates.” – by Mark E. Neumann

Reference:

Harhay, MN, et al. Abstract TH-OR123. Presented at: ASN Kidney Week; Oct. 23-28, 2018; San Diego.

Disclosure: The author reported no relevant financial disclosures.