Obese Patients Wait Longer For Kidney Transplants, Research Suggests

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Obese Patients Wait Longer For Kidney Transplants, Research Suggestshttp://www.medicalnewstoday.com/articles/92350.phpNew research from s Hopkins specialists suggests that obese kidney

disease patients face not only the usual long odds of a tissue match

and organ rejection, but also are significantly less likely than

normal-weight people to receive a kidney transplant at all. The s Hopkins study results, to be published online this Wednesday in the Journal of the American Society of Nephrology,

reveal that morbidly obese patients (those who on average weigh 100

pounds more than their ideal weight) are on the transplant waiting list

for a median of five years - two years more than the median wait time

for a patient of normal weight.

Because patients tend to get sicker the longer they wait on dialysis,

obese patients are 44 percent less likely than normal-weight patients

to ever receive a kidney transplant, the researchers report. Each year,

8 percent of the patients on the list die waiting for a kidney.

s Hopkins transplant surgeon Dorry Segev, M.D., who led the study,

suggests that obese patients might be turned down, sometimes multiple

times, because of the added cost and poorer outcome associated with

transplants in overweight patients.

" Being overweight should not be a disqualifying and discriminating factor against these patients, " Segev says.

He adds that at s Hopkins, the rate at which overweight, severely

obese, and morbidly obese patients are listed and receive transplants

is much higher than the national average. As a result, the waiting

times for obese patients are not significantly different.

" Patients understandably believe that being placed on the transplant

waiting list is an implicit promise of fair, unbiased treatment under a

transparent allocation scheme, " Segev says. " Unfortunately, the system

that has been established nationally may not be living up to that

promise. "

The study's findings may be explained, he says, by economic pressures

as well as medical ones. He notes that Medicare - the principal insurer

for kidney transplants - pays a set amount for the operation regardless

of a patient's overall health, difficulty of the operation, length of

stay, postoperative care and complications, all of which may increase

substantially with obese patients. Transplant centers, therefore, may

be under pressure to avoid operating on these individuals.

In addition, Segev says, centers with lower surgical survival rates overall risk losing Medicare funding.

The researchers analyzed data from 132,353 men and women with kidney

disease who were on the United Network for Organ Sharing (UNOS)

deceased donor kidney transplantation list from 1995 to 2006 in the

United States.

Patients' weight was rated using the body mass index (BMI) scale -

weight in kilograms divided by height in meters squared. A normal BMI

is 18.5. Overweight is 25 (25 to 30), obese is 30 to 35 severely obese

is 35 to 40 and morbidly obese is 40 to 60.

Of the group analyzed, 48,349 were of normal weight, 45,411 were

overweight, 25,509 were obese, 9,479 were severely obese and 3,605 were

morbidly obese.

After adjusting for additional health factors that might affect a

person's eligibility for transplantation (such as blood type, age, type

of kidney disease, diabetes and heart disease), the researchers found

that the likelihood of receiving a transplant, when compared to

patients with a normal weight, decreases by 4 percent for overweight

patients, 7 percent for obese patients, 28 percent for severely obese

patients and 44 percent for morbidly obese patients.

Segev says the number of overweight patients joining the UNOS waiting

list has gone up markedly in the last decade as the rate of obesity has

grown in the U.S. population. From 1995 to 2005, the number of severely

obese patients added to the list increased by 310 percent, and the

number of morbidly obese patients added to the list increased by 247

percent. In contrast, the number of people of normal weight added to

the list increased by only 33 percent.

" The transplant community needs to develop appropriate guidelines

stipulating which patients are appropriate for transplantation and to

do our best to treat them equally, " says Segev. " Similarly, both

outcomes evaluation and reimbursement need to reflect the varying

difficulty of care for these patients in order to remove the

disincentives of taking on challenging cases. "

A study by s Hopkins surgeon Anne Lidor, M.D., is currently

examining whether overweight transplants patients should be recommended

for gastric bypass surgery at the time they're first listed.

" This would improve survival while the patient is waiting for a kidney

and also improve survival after receiving the kidney, which should

eliminate any potential bias for receiving a kidney in a timely

fashion, " says Segev.

Additional s Hopkins researchers who contributed to this paper

include A. Montgomery, M.D., Ph.D.; E. Simpkins,

M.D.; Jayme E. Locke, M.D.; and S. Warren, Ph.D., of the

Department of Surgery; and E. , Ph.D., of the Bloomberg

School of Public Health. s Hopkins Medicine

901 S. Bond St., Ste 550

Baltimore, MD 21231

United States

http://www.hopkinsmedicine.org