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Living Donor Research Living Donor Risks Living Kidney Donor

How Many Living Kidney Donors Were Obese Pre-Donation?

47,705 adult living kidney donors as reported to OPTN from 1999 to 2011 were analyzed using their pre-donation BMI (body mass index)

  • 35.6% were normal weight.
  • 40.5% were overweight
  • 18.9% were mildly obese
  • 4.2% were moderate to morbidly obese
  • Overweight and mildly obese kidney donors have increased through time by 12% and 20% every 5 years, respectively
  • 63.6% of living kidney donors over the past thirteen years have spanned the overweight to obese categories

 

According to OPTN guidelines, having a BMI greater than 35 kg/m2 is considered a relative contraindication to be a living kidney donor. However, based on a 2007 survey, 20% of transplant centers surveyed excluded those with BMI greater than 40 kg/m2 , 52% excluded donors with BMI greater than 35 kg/m2 , 10% excluded those with BMI over 30 kg/m2 , 12% percent had no policy for exclusion, and 6% excluded based on BMI if they had other cardiovascular risks.

  • Short term outcomes of obese living kidney donors have shown increased wound related complications and longer operative times
  • At five year follow up, Kramer et al found that overweight and obese individuals had 20% and 40% risk of developing chronic kidney disease.
  • Having a higher baseline BMI can serve as an independent risk factor for end stage kidney disease.
  • The long term effects of obesity on the solitary kidney of a kidney donor are still uncertain. This risk factor increases the risk of developing other co-morbid conditions such as diabetes mellitus, hypertension, or even proteinuria which can together compromise the function of their solitary kidney
  • At a mean of 11 year follow up, obese donors had an increased risk of developing hypertension and dyslipidemia.

 

Read the entire article at the link (above). Take care of yourselves.

 
Sachdeva, M. (2015). Weight trends in United States living kidney donors: Analysis of the UNOS database World Journal of Transplantation, 5 (3) DOI: 10.5500/wjt.v5.i3.137

Categories
Advocacy Informed Consent Living Donor Research Living Donor Risks Living Kidney Donor OPTN

63.6% of Living Kidney Donors Are Overweight

An analysis of the OPTN/UNOS database from 1999-2011 reveals that 63.6% of all living kidney donors were either overweight* or obese.

(emphasis mine):

“Overweight and mildly obese kidney donors have increased through time by 12% and 20% every 5 years, respectively “

 

Obesity is associated with numerous health risks, including Type 2 Diabetes and hypertension. According to USRDS, 44% of kidney failure is due to diabetes and another 26% is because of high blood pressure.

And:

“Having a BMI greater than 35 kg/m2 has been associated with slightly longer operative times and overall more peri-opera­tive complications, such as wound complications”

 

If obesity is such a problem, especially in regards to kidney function and health, wouldn’t OPTN have some sort of policy on the matter? (emphasis mine again)

 

According to OPTN guidelines, having a BMI greater than 35 kg/m2 is considered a relative contraindication to be a living kidney donor. Despite this, transplant centers across the United States use different criteria in determining donor exclusion based on BMI. Based on a 2007 United States Transplant Center Survey, twenty percent of the transplant centers that were surveyed excluded those with BMI greater than 40 kg/m2, fifty two percent of United States kidney transplant centers excluded donors with BMI greater than 35 kg/m2, ten percent of programs excluded those with BMI over 30 kg/m2, twelve percent had no policy for exclusion, and six percent excluded based on BMI if they had other cardiovascular risks. ”

 

In short, only 60% of U.S. transplant centers follow or exceed OPTN policy.

40% of U.S. transplant centers accept higher at-risk living kidney donors than OPTN policy dictates.

 

There’s no point in having a policy if 40% of members won’t follow it. Especially if the governing organization will do nothing to enforce it. The whole thing is nothing more than theater, engineered to make the public *believe* transplant centers care about the health and well-being of kidney donors.

Unfortunately, it’s theater that’s already put over 30,000 people at risk.

 

 

*Overweight was defined as a BMI of 25 or higher.

Sachdeva, M. (2015). Weight trends in United States living kidney donors: Analysis of the UNOS database World Journal of Transplantation, 5 (3) DOI: 10.5500/wjt.v5.i3.137

Categories
Living Kidney Donor

Obesity (BMI of 35 or higher) Causing Potential Living Kidney Donor Rejections

Of 450 living kidney donor candidates, 398 were rejected for donation and 52 were approved. Candidates who were rejected had a mean BMI of 28.9 kg/m2, which was significantly higher than the mean 25.9 kg/m2 for the approved group,

Of candidates approved for donation, only 11.5% were obese (BMI above 30) and 88.5% were non-obese (BMI below 30). Regardless of whether candidates were obese or not, whites were more likely to be approved for donation than non-whites (12.3% vs. 5%-6% of blacks and other race/ethnicities). Among the obese, non-whites were never approved for donation, she reported.

Dr. Stewart noted that a BMI above 35 is an absolute exclusion criterion for donation at her institution. In the study, 42.5% of prescreen denials were due to a BMI above 35.

 

In the other study, Deonna Moore, MSN, and colleagues at Vanderbilt University Medical Center in Nashville, Tenn., analyzed data from 967 potential donors. Of these, 212 (22%) were ineligible to donate, and 140 of them (66%) were excluded because they had a BMI of 35 or higher.

 

Full article: http://www.renalandurologynews.com/obesity-often-thwarts-living-kidney-donation/article/294116/#

Categories
Living Donor Risks Living Kidney Donor

A Couple of Notes on the Obese Kidney Donor Issue

Last May, I wrote about a press release barrage from the North Shore Long Island Jewish Health System that blatantly said American obesity was a problem because it interfered with the transplant industry’s ability to take their living donor kidneys.

In August, the NY Times wrote an article framed around one gentlemen but spattered with quote and facts from multiple New York based transplant centers, which drew no conclusions other than “dude lost weight so we took his kidney”.

I missed it until now, but at least one doctor weighed in on the topic with a “hold on, all is not well” sort of warning:

To the Editor:

Re “Transplant Centers Struggle With Donors’ Obesity” (Aug. 7): The concern for possible kidney failure in obese living kidney donors is not without justification. In 2010, Dr. Stephen Bartlett and his colleagues at University of Maryland published in the journal Transplantation their findings of follow-up of obese donors at an average of seven years after surgery. They found that kidney function in almost half had dropped to less than 60 milliliters per minute, considered Stage 3 chronic renal disease. (Stage 5 requires dialysis.)

Unfortunately, as the article reported, only 10 percent of transplant centers exclude living donors who are obese, and about half of transplant centers accept living donors who are morbidly obese, subjecting these individuals to additional risks of hypertension, kidney failure and even death.

Jim Bowman, M.D.

Rockville, Md.

 

This has been my point all along (and not just for high BMI living kidney donors). The transplant industry must stop focusing on surgical complications (and using them to justify living donation’s so-called safety), and turn their attention to the WAY long-term that every living donor experiences with one kidney or a reconstituted liver. While I understand that we are of no use to the transplant industry after our organs are removed, we certainly are valuable to our families, friends, and most of all, to ourselves. At the bare minimum, we deserve treatment equal to that given to our recipient, and that includes a ten-year, comprehensive registry. Not the patronizing “trust us, you’ll be fine” pat on the head we’ve gotten so far.

Categories
Follow-Up Living Donor Research Living Donor Risks Living Kidney Donor

Obesity aka High BMI and Living Kidney Donation

A recent meta-analysis claims that high BMI (30 and above) does not affect the short-term results of living kidney donation (live donor nephrectomy).

I took a look at the study, since it was being lauded in an online living donor group, and I want to copy/paste what I said there, here:

 

Like so many other published articles regarding living donation, I suspect the conclusions drawn by the researchers are not as iron-clad as some might want to believe.

The meta-analysis clearly says higher BMI results in longer surgical time, higher rate of conversions from lap to open, and a longer ischemic time for the donated kidney. These things are not incidental. Remember, that there is a steep operator learning curve for the lap procedure, meaning that the more inexperienced surgeon has a higher risk of complications, so it’s important to ask a prospective surgeon how many of the lap live donor nephrectomy procedures s/he has done.

The results also show a higher creatinine level in high BMI donors as well as a lower GFR. I pulled up the studies to see when the measures were taken.

Kuo – 1 wk
Mateo – at discharge from the hospital
Heimbach – 6-12 months
Rea – median of 340 days
Espinoza – 50.8 ± 28.5 months <- showed lower GFR in high BMI donors
Rook – 2 months
Tavakol – 11 ± 7 yrs <- (some of the LKDs in this study were low BMI at the time of donation, but were high BMI at the time of this study, which altered the comparison results)
Reese – 6 months. <- But they used the OPTN database, which was deemed “useless” for research or analysis for anything after 6 weeks.

As the researchers were clear to point out, they were only looking at the SHORT term risks of high BMI. Because the average living kidney donor in the U.S. is 41, we have a whole lot of LONG term to worry about, and no valid or reliable data to rely on. High BMI (obesity) puts strain on the kidneys and the heart. Reduced kidney function also increases the risk of cardiovascular disease and death.

So while I understand that the certain facets of the transplant industry are always looking for ways to justify more living kidney donors, we’d all be better off if we concentrated on preventing and treating diabetes and hypertension, which account for the majority end-stage renal disease diagnosis in the U.S.

 

Addendum: Researchers conducting meta-analysis always have the option of making a conclusion equivalent to – hey, the results are mixed, we really need to do more research on the subject. Such a declaration would’ve been appropriate here. The fact the authors chose to say there were no short term risks to a high BMI person donating a kidney reflects their preference.

 

Lafranca JA, Hagen SM, Dols LF, Arends LR, Weimar W, Ijzermans JN, & Dor FJ (2013). Systematic review and meta-analysis of the relation between body mass index and short-term donor outcome of laparoscopic donor nephrectomy. Kidney international PMID: 23344469