Unintended weight loss before kidney transplant evaluation tied to lower listing odds
Key takeaways:
- Stable weight, unintentional weight loss and weight gain were associated with lower odds of waitlisting for frail candidates with obesity.
- Weight change did not affect waitlisting for non-frail candidates.
Unintentional weight loss prior to kidney transplant evaluation may be linked to lower listing odds and higher waitlist mortality for frail patients with obesity, a study found.
“Almost all transplant centers restrict access to [kidney transplant] KT for patients with obesity because of higher surgical complications arising from this comorbidity. Clinical guidelines recommend weight loss for [end-stage kidney disease] ESKD patients with obesity to enhance KT candidacy,” Nidhi Ghildayal, PhD, MPH, a senior research scientist at the NYU Grossman School of Medicine and NYU Langone Health in New York, and colleagues wrote. “However, weight loss predicts adverse outcomes in KT candidates.”
Researchers analyzed data from 1,361 candidates for kidney transplant, including 895 patients on the transplant waitlist, who had a BMI of at least 30 kg/m² and who were considered to have obesity. The study aimed to test the relationship between pre-evaluation weight change and transplant waitlisting and waitlist mortality.
Investigators focused on weight loss intention and frailty during the year before evaluation.
Of transplant candidates with obesity, 48% had stable weight, 17% gained weight, 16% unintentionally lost weight and 20% purposely lost weight prior to evaluation.
Adjusted hazard ratios showed that among frail candidates with obesity, stable weight was tied to a 27% lower chance of being listed for kidney transplant vs. non-frail candidates with stable weight (aHR = 0.73; 95% CI, 0.55-0.96). Patients who gained weight had a 47% lower chance of listing (aHR = 0.53; 95% CI, 0.34-0.80) and those who lost weight unintentionally had a 48% lower chance of listing (aHR = 0.52; 95% CI, 0.32- 0.84).
Compared with non-frail candidates with stable weight, frail candidates with obesity at baseline who had stable weight, unintentional weight loss and intentional weight loss had higher risks for dying while on the transplant waitlist, as seen the respective adjusted sub-hazard ratios (aSHR = 1.72; 95% CI, 1.01-2.90), (aSHR = 2.78; 95% CI, 1.23-6.27) and (aSHR = 2.26; 95% CI, 1.05-4.85).
In contrast, researchers found weight change and frailty status did not affect the chance of listing or waitlist mortality for non-frail candidates.
“A more granular examination of which methods of weight loss before KT, such as exercise, nutritional improvements, obesity pharmacotherapy or other interventions, may be most beneficial for frail candidates particularly is needed,” according to the researchers. “However, our findings suggest that among frail candidates with obesity, caregivers must carefully supervise and monitor pre-KT weight loss, with emphasis placed on strategies to preserve muscle mass and function.”
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