PracticeUpdate Conference Series ISN WCN 2019

High BMI May Not Be Barrier to Successful Kidney Transplantation Modern immunosuppressive strategies appear to bemaking obesity a less important prognostic factor. I n the modern immunosuppressive era, having a high body mass index (BMI) is far less likely to contribute to graft failure following kidney transplantation than it once did, according to a registry analysis. The find- ings add to mounting evidence that excluding people with high BMIs from kidney transplant lists may be a strategy that warrants re-evaluation. The data were presented in a poster by Ye Na Kim, MD, of Kosin University College of Medicine, Gospel Hospital in Busan, South Korea. Dr. Kim and colleagues used data from the United Network for Organ Sharing (UNOS) to identify 69,749 people who received a kidney transplant between 1987 and 1999, as well as another 197,986 who received a kidney transplant between 2000 and 2016. The more recent time period represents those patients who were treated using modern immunosuppressive strategies. The investigators used multivariate analysis to com- pare the two groups with respect to the effect of BMI on graft and patient outcomes, adjusting for factors known to affect graft success and patient survival. Their analysis revealed that the relative risk of graft loss, patient death, and patient death with a function- ing graft has significantly diminished in the modern immunosuppressive era of 2000 to 2016, compared with the earlier era of 1987 to 1999. This effect was especially strong among living kidney transplant recipients. Most importantly, the relative risk of graft loss and patient death with graft function as a function of increasing BMI has also diminished substantially. “The risk of kidney failure and patient death among kid- ney transplant recipients with a high BMI has reduced in the modern immunosuppressive era,” session mod- erator Toby Coates, MD, of the University of Adelaide, South Australia, told Elsevier’s PracticeUpdate . “Because of this, and particularly because people are dying because of lack of transplants, maybe it is time to consider doing transplants in more obese people than we previously have. Withholding is not a good idea.” Dr. Coates noted that high BMI remains a major barrier to transplant listing. While additional registry studies and possibly even clinical trials evaluating the out- come of transplant patients with high BMIs will be needed to change this practice, he pointed out that the data pointing in this direction are mounting all over the world. Very similar findings were recently presented in an analysis of registry data from the United Kingdom Transplant Registry.

risk factor for acute kidney disease, followed by diarrhea, hypotension and appetite loss. At discharge, the overall mortality rate was 5%. At 6 months, this had increased to 13%. For those patients with no renal dysfunction, the mortality rate at discharge was 3.4% and at 6 months was 6.4%. In patients with acute kidney injury, mortality was 3.1% at discharge and 13.7% at 6 months. Patients with acute kidney disease had a mortality rate of 7.3% at discharge and 16.1% at 6 months. Patients with chronic kidney disease had the highest mortality rate, with 10.3% at discharge and 24.5% at 6 months. A cohort of 434 patients underwent 3-month serum creatinine follow-up. In this group, new onset chronic kidney disease was found in 40 (26%) patients with acute kidney disease and 54 (33%) patients with an acute kidney injury. Among the patients who died from chronic or acute kidney disease, 31 (11%) did not receive dialysis. The authors concluded in their abstract that community-acquired acute kidney injury is common in low-resource settings which, left unde- tected, can result in chronic kidney disease progression and even death. Screening for comorbidities along with specific signs and symptoms can help identify at-risk patients who may benefit from point-of-care testing, such as serum creatinine or urine dipstick testing, at community health centers and emergency departments. " Among the patients who died from chronic or acute kidney disease, 31 (11%) did not receive dialysis. "

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WCN 2019 • PRACTICEUPDATE CONFERENCE SERIES 19