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. 2022 May 16;3(8):1411-1416.
doi: 10.34067/KID.0001682022. eCollection 2022 Aug 25.

Guiding Kidney Transplantation Candidates for Effective Weight Loss: A Clinical Cohort Study

Aleksandra Kukla  1   2 , Tayyab Diwan  2   3 , Byron H Smith  2 , Maria L Collazo-Clavell  4 , Elizabeth C Lorenz  1   2 , Matthew Clark  4   5 , Karen Grothe  4   5 , Aleksandar Denic  1 , Walter D Park  2 , Sukhdeep Sahi  1 , Carrie A Schinstock  1   2 , Hatem Amer  1   2 , Naim Issa  1   2 , Andrew J Bentall  1   2 , Patrick G Dean  2   3 , Yogish C Kudva  2   4 , Manpreet Mundi  4 , Mark D Stegall  2   3
Affiliations

Guiding Kidney Transplantation Candidates for Effective Weight Loss: A Clinical Cohort Study

Aleksandra Kukla et al. Kidney360. .

Abstract

Background: Obesity is increasingly common in kidney transplant candidates and may limit access to transplantation. Obesity and diabetes are associated with a high risk for post-transplant complications. The best approach to weight loss to facilitate active transplant listing is unknown, but bariatric surgery is rarely considered due to patient- and physician-related apprehension, among other factors.

Methods: We aimed to determine the magnitude of weight loss, listing, and transplant rates in 28 candidates with a mean BMI of 44.4±4.6 kg/m2 and diabetes treated conservatively for 1 year post weight-loss consultations (group 1). Additionally, we evaluated 15 patients (group 2) who met the inclusion criteria but received bariatric intervention within the same time frame. All patients completed a multidisciplinary weight management consultation with at least 1 year of follow-up.

Results: In the conservatively managed group (group 1), the mean weight at the time of initial consultation was 126.5±18.5 kg, and the mean BMI was 44.4±4.6 kg/m2. At 1 year post weight-loss consultation, the mean weight decreased by 4.4±8.2 kg to 122.9±17 kg, and the mean BMI was 43±4.8 kg/m2, with a total mean body weight decrease of 3% (P=0.01). Eighteen patients (64%) did not progress to become candidates for active listing/transplantation during the follow-up time of 4±2.9 years, with 15 (54%) subsequently developing renal failure/diabetes-related comorbidities prohibitive for transplantation. In contrast, mean total body weight decreased by 19% at 6 months post bariatric surgery, and the mean BMI was 34.2±4 and 32.5±3.7 kg/m2 at 6 and 12 months, respectively. Bariatric surgery was strongly associated with subsequent kidney transplantation (HR=8.39 [95% CI 1.71 to 41.19]; P=0.009).

Conclusions: A conservative weight-loss approach involving multidisciplinary consultation was ineffective in most kidney transplant candidates with diabetes, suggesting that a more proactive approach is needed.

Keywords: BMI; bariatric surgery; cohort studies; diabetes; dialysis; kidney transplant candidates; mortality; obesity; transplantation; weight loss.

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Conflict of interest statement

H. Amer reports research funding from Kaneka Pharma and the US Department of Defense; honoraria from the Massachusetts Medical Society; and an advisory or leadership role for Transplantation (associate editor), the American Society of Transplantation (VCA advisory council co-chair), the American Society for Reconstructive Transplantation (board member), the International Society of Vascularized Composite Allotransplantation (councilor), and The Transplantation Society (education committee member). Y.C. Kudva reports consultancy for Medtronic and Novo Nordisk; research funding from Dexcom; and an advisory or leadership role for Diabetes Technology and Therapeutics. A. Kukla reports research funding as the site subinvestigator on the multicenter international study “A Research Study to See How Semaglutide Works Compared to Placebo in People with Type 2 Diabetes and Chronic Kidney Disease (FLOW)” sponsored by Novo Nordisk, and honoraria from UpToDate. M. Mundi reports research funding from Fresenius Kabi, Nestle, Realfood Blends, and VectivBio, and an advisory or leadership role for Baxter. C. Schinstock reports research funding from CSL Bering, Sanofi, and Veloxis; honoraria from CSL Bering and Veloxis; and an advisory or leadership role for Veloxis. All remaining authors have nothing to disclose. All remaining authors have nothing to disclose.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Change in body mass index (BMI) in kidney transplant candidates based on surgical and nonsurgical weight-loss management. (A) Baseline BMI of 44.4±4.6 kg/m2 and BMI change at 1 and 2 years post weight management evaluation with minimal improvement. Statistical improvement at 1 year was mean BMI drop by 1.4 kg/m2 (P = 0.01), but at 2 years, this was unchanged (P = 0.8). (B) The rapid reduction in BMI at 6 months (mean BMI 43.4±4.4 kg/m2 to 34.2±4 kg/m2), which was then sustained at 1 year post initial evaluation (BMI 32.5±3.7 kg/m2).
Figure 2.
Figure 2.
Comparison of rates of kidney transplantation based on surgical and nonsurgical weight-loss management.
See this image and copyright information in PMC

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References

    1. Centers for Disease Control and Prevention : Adult Obesity Facts. Available at: https://www.cdc.gov/obesity/data/adult.html. Accessed April 24, 2022
    1. Ward ZJ, Bleich SN, Cradock AL, Barrett JL, Giles CM, Flax C, Long MW, Gortmaker SL: Projected U.S. state-level prevalence of adult obesity and severe obesity. New Engl J Med 381: 2440–2450, 2019. 10.1056/NEJMsa1909301 - DOI - PubMed
    1. Pondrom S: The AJT report: News and issues that affect organ and tissue transplantation. Am J Transplant 12: 1663–1664, 2012. 10.1111/j.1600-6143.2012.04186.x - DOI - PubMed
    1. Hart A, Smith JM, Skeans MA, Gustafson SK, Wilk AR, Castro S, Foutz J, Wainright JL, Snyder JJ, Kasiske BL, Israni AK: OPTN/SRTR 2018 annual data report: Kidney. Am J Transplant 20: 20–130, 2020. 10.1111/ajt.15672 - DOI - PubMed
    1. Lesage J, Gill JS: Management of the obese kidney transplant candidate. Transplant Rev (Orlando) 31: 35–41, 2017. 10.1016/j.trre.2016.12.002 - DOI - PubMed