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BMI does not appear to hinder African American patients’ access to transplantation
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While African American patients have a higher prevalence of obesity and overweight status and continue to experience disparities in access to kidney transplantation, BMI does not appear to be a barrier for transplant referral.
The exclusion criteria of many transplant centers for BMI is between 35 kg/m2 and 40 kg/m2. Although African American patients are still less likely to receive a transplant, the likelihood of obese African American patients to get a transplant referral appeared to be no different than their normal-weight counterparts, according to the research letter.
Investigators behind this research letter aimed to study the perception of African American patients on dialysis regarding their BMI and its association to transplantation access.
“[In] dialysis patients, increased [BMI] is paradoxically linked with improved survival for both overweight and obese patients, defined as BMI of 25 [kg/m2] to 29.9 [kg/m2] and BMI [of at least] 30 kg/m2, respectively,” the authors of the research letter wrote. “[However], kidney transplantation in obese candidates is associated with worse short-term outcomes, including longer surgical times, increased postoperative complications and delayed graft function.”
Researchers surveyed 127 African American patients on dialysis, of which 32 were considered overweight, 50 were considered obese and 82% had completed 12 or more years of school. Mean BMI of the patient group was 27.3 ± 7.3 kg/m2.
Patients on the South Side of Chicago who received treatment from June to July 2016 in three university-affiliated DaVita dialysis units were surveyed on their perceptions of ideal weight, exercise, transplantation eligibility and lifestyle.
The surveys found most of the patients preferred to be at an overweight BMI. Investigators noted there may be an association between overweight patients on dialysis and improved survival.
“Only a small proportion of our sample was above the local transplantation center’s BMI cutoff, despite a high prevalence of obesity and overweight,” the authors wrote. “Obese and overweight African Americans’ rates of referral for transplantation evaluation and appearance on the waitlist did not differ significantly from their normal-weight counterparts.”
However, 40% of surveyed participants stated they had not received evaluation. Of those patients, more than 70% were either uninterested in evaluation or uninterested in transplant.
According to the study, the percentage of surveyed patients on dialysis who had a transplantation evaluation completed or in progress was 59.2% if obese, 66.7% if overweight, 57.1% if normal weight and 33.3% if underweight.
Additionally, within the group of patients who received evaluation (n=67), the proportion waitlisted was 60% if obese, 71% if overweight and 55% if normal BMI.
“Continued efforts should focus on ensuring that all hemodialysis patients, regardless of race or BMI, are aware of the benefits of transplantation and have the emotional and material supports necessary to consider and complete the transplantation evaluation,” the authors wrote. “Hemodialysis providers can work to reduce disparities by providing all patients with education on the benefits of transplantation, early referral for transplantation and assistance in timely completion of the transplantation evaluation.” – by Scott Buzby
Disclosures: The authors report no relevant financial disclosures.
Perspective
Back to TopDavid Klassen, MD
The obesity epidemic affects the specialty of transplantation as surely as it does the rest of medicine. Gupta and colleagues highlight the particularly complex relationship between obesity and listing for kidney transplantation for African American dialysis patients. African Americans have a higher incidence of obesity and lower rates of listing for kidney transplantation. Once listed, however, their rate of transplantation is similar to other ethnic groups. Although most transplant centers have BMI criteria for placing patients on the kidney transplant waiting list, there is little current relationship between BMI and patient and graft survival.
Gupta and colleagues found a high percentage of African American dialysis patients had not been referred for transplantation or were not interested in transplantation. If African American patients with ESRD are to more fully access the clear benefits of kidney transplantation, the barriers to transplantation listing faced by African Americans will require additional focused patient and provider education.
United Network for Organ Sharing
Richmond, Virginia
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