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  • Obesity as a barrier to kidney transplantation: Time to eliminate the body weight bias?

    Author(s)
    MacLaughlin, Helen L
    Campbell, Katrina L
    Griffith University Author(s)
    Campbell, Katrina
    Year published
    2019
    Metadata
    Show full item record
    Abstract
    There is clear evidence that survival rates following transplantation far exceed those for remaining on dialysis, regardless of body size measured by body mass index (BMI). Studies over the past 15 years also suggest little to no difference in long‐term outcomes, including graft survival and mortality, irrespective of BMI, in contrast to earlier evidence. However, weight bias still exists, as access to kidney transplantation remains inequitable in centers using arbitrary BMI limits. Clinicians faced with the decision regarding listing based on body size are not helped by conflicting recommendations in national and international ...
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    There is clear evidence that survival rates following transplantation far exceed those for remaining on dialysis, regardless of body size measured by body mass index (BMI). Studies over the past 15 years also suggest little to no difference in long‐term outcomes, including graft survival and mortality, irrespective of BMI, in contrast to earlier evidence. However, weight bias still exists, as access to kidney transplantation remains inequitable in centers using arbitrary BMI limits. Clinicians faced with the decision regarding listing based on body size are not helped by conflicting recommendations in national and international guidelines. Therefore, in clinical practice, obesity, and recommendations for weight loss, remain a controversial issue when assessing suitability for kidney transplantation. Obesity management interventions in end‐stage kidney disease (ESKD), whether for weight loss for transplantation listing or for slowing kidney disease progression, are under‐explored in trial settings. Bariatric surgery is the most successful treatment for obesity, but carries increased risk in the ESKD population, and the desired outcome of kidney transplant listing is not guaranteed. Centers that limit transplants to those meeting arbitrary levels of body mass, rather than adopting an individualized assessment approach, may be unfairly depriving many ESKD patients of the survival and quality of life benefits derived from kidney transplantation. However, robotic kidney transplantation surgery holds promise for reducing perioperative risks related to obesity, and may therefore represent an opportunity to remove listing criteria based on size.
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    Journal Title
    Seminars in Dialysis
    Volume
    32
    Issue
    3
    DOI
    https://doi.org/10.1111/sdi.12783
    Subject
    Clinical sciences
    Science & Technology
    Life Sciences & Biomedicine
    Urology & Nephrology
    LAPAROSCOPIC SLEEVE GASTRECTOMY
    RECIPIENT OBESITY
    Publication URI
    http://hdl.handle.net/10072/388341
    Collection
    • Journal articles

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