 |
|
Extreme obesity affects chances of kidney transplantation
January 11, 2008Study raises concerns about bias in organ waiting list decisions
For patients on the waiting list for a kidney transplant, severe and morbid obesity are associated with a lower chance of receiving an organ, reports a study in the February Journal of the American Society of Nephrology.
Led by Dr. Dorry L. Segev of the Johns Hopkins University School of Medicine, the researchers used data from the United Network for Organ Sharing (UNOS) to examine how obesity affects waiting times for kidney transplantation. "The results identify a potential bias in organ allocation that is not consistent with the goals of our allocation system," Dr. Segev comments. "Obese patients are waiting longer for kidney transplants when compared with their non-obese counterparts, even after adjusting for all medical factors tracked through UNOS."
Dr. Segev and colleagues analyzed data on more than 132,000 patients wait-listed for kidney transplants from 1995 to 2004. As obesity increased, the likelihood of receiving a transplant decreased.
Adjusted for other factors, the chances of receiving a kidney transplant were 27 percent lower for patients classified as severely obese and 44 percent lower for morbidly obese patients, compared to normal-weight patients. (The chances of receiving a transplant were not significantly reduced for patients classified as overweight or mildly obese.)
In addition, when a kidney became available, patients in the highest categories of obesity were more likely to be "bypassed"-that is, their physician was more likely to decline the offer of a kidney. The chances of being bypassed were 11 percent higher for severely obese patients and 22 percent higher for morbidly obese patients.
The findings raise concerns that obesity may be a previously unappreciated source of bias in organ allocation. "It is possible that providers are bypassing obese patients and instead transplanting non-obese patients because they feel that kidneys are a scarce resource and they want the kidneys to go to the patients who will benefit most from them," says Dr. Segev. "However, there is strong evidence that even obese patients will benefit significantly from a kidney transplant. And more importantly, the U.S. organ allocation system is not based on such medical decisions, but instead is based on the notion that everyone who gets listed deserves a fair chance at getting transplanted."
The bias might play out in other ways as well. Obese patients tend to have worse outcomes, which may reflect badly on the results achieved by doctors or hospitals-possibly even affecting quality measurements, which are increasingly tied to reimbursement. In addition, the reimbursement for transplant surgery is the same for difficult or complicated cases as for simpler cases. "These two practices generate a strong disincentive against challenging cases, and could potentially contribute to the bias against obese patients that we saw in our study," says Dr. Segev.
Dr. Segev notes that matching an available organ with an appropriate recipient requires clinical judgment, which could not be fully captured in this study. "However," he adds, "it is unlikely that these factors could explain such dramatic observations."
American Society of Nephrology
Dr. Segev and colleagues analyzed data on more than 132,000 patients wait-listed for kidney transplants from 1995 to 2004. As obesity increased, the likelihood of receiving a transplant decreased.
Adjusted for other factors, the chances of receiving a kidney transplant were 27 percent lower for patients classified as severely obese and 44 percent lower for morbidly obese patients, compared to normal-weight patients. (The chances of receiving a transplant were not significantly reduced for patients classified as overweight or mildly obese.)
In addition, when a kidney became available, patients in the highest categories of obesity were more likely to be "bypassed"-that is, their physician was more likely to decline the offer of a kidney. The chances of being bypassed were 11 percent higher for severely obese patients and 22 percent higher for morbidly obese patients.
The findings raise concerns that obesity may be a previously unappreciated source of bias in organ allocation. "It is possible that providers are bypassing obese patients and instead transplanting non-obese patients because they feel that kidneys are a scarce resource and they want the kidneys to go to the patients who will benefit most from them," says Dr. Segev. "However, there is strong evidence that even obese patients will benefit significantly from a kidney transplant. And more importantly, the U.S. organ allocation system is not based on such medical decisions, but instead is based on the notion that everyone who gets listed deserves a fair chance at getting transplanted."
The bias might play out in other ways as well. Obese patients tend to have worse outcomes, which may reflect badly on the results achieved by doctors or hospitals-possibly even affecting quality measurements, which are increasingly tied to reimbursement. In addition, the reimbursement for transplant surgery is the same for difficult or complicated cases as for simpler cases. "These two practices generate a strong disincentive against challenging cases, and could potentially contribute to the bias against obese patients that we saw in our study," says Dr. Segev.
Dr. Segev notes that matching an available organ with an appropriate recipient requires clinical judgment, which could not be fully captured in this study. "However," he adds, "it is unlikely that these factors could explain such dramatic observations."
American Society of Nephrology
Kidney Transplant News and Current Kidney Transplant Events RSSTrapping white blood cells proves novel strategy against chronic viral infections
Seeing disease-fighting white blood cells vanish from the blood usually signals a weakened immune system. But preventing white blood cells' circulation by trapping them in the lymph nodes can help mice get rid of a chronic viral infection, researchers at Yerkes National Primate Research Center and the Emory Vaccine Center have found.
Trapping white blood cells proves novel strategy against chronic viral infections
Seeing disease-fighting white blood cells vanish from the blood usually signals a weakened immune system. But preventing white blood cells' circulation by trapping them in the lymph nodes can help mice get rid of a chronic viral infection, researchers at Yerkes National Primate Research Center and the Emory Vaccine Center have found.
NewYork-Presbyterian/Columbia leads research into robotic surgery for kidney cancer
Clinical research at NewYork-Presbyterian Hospital/Columbia University Medical Center is helping bring the advantages of robotic surgery, including reduced pain and quicker recovery, to kidney cancer patients.
'Statins' linked to improved survival in kidney transplant recipients
For patients receiving kidney transplants, treatment with cholesterol-lowering "statin" drugs may lead to longer survival, reports a study in the November 2008 Journal of the American Society of Nephrology (JASN).
New protocol streamlines therapy that makes more kidney transplants possible
A new therapy developed at Cedars-Sinai Medical Center improves transplant rates and outcomes for patients awaiting living- and deceased-donor kidney transplantation, according to a study published in the July 17 issue of the New England Journal of Medicine.
Kidney transplants less successful at night
Kidney transplants should be carried out during the day if possible. At least this is the conclusion suggested by a survey just published by urologists and internists at the University of Bonn.
Immune molecule that plays a powerful role in avoiding organ rejection identified
When a mouse's immune system is deciding whether to reject a skin graft, one powerful member of a molecular family designed to provoke such a response can effectively reduce the visibility of the mouse's own cells and help the graft survive, researchers say.
Drug may prolong organ life in noncompliant kidney transplant patients
New research from the University of California, San Diego Department of Medicine, Division of Nephrology, shows that the anti-rejection drug sirolimus (brand name Rapamune) may help prolong the clinical benefit of transplanted kidneys and delay rejection, especially in patients who do not regularly take their prescribed medications (are "non-compliant").
Anti-rejection drug may increase risk of diabetes after kidney transplant
For patients undergoing kidney transplantation, treatment with the anti-rejection drug sirolimus may lead to an increased risk of diabetes, reports a study in the July Journal of the American Society of Nephrology (JASN).
Hidden heart condition increases the risk of death in patients waiting for kidney transplants
An often asymptomatic condition-systolic dysfunction, or decreased pumping of the heart-poses an increased risk of death for patients on kidney transplant waiting lists, according to a study appearing in the June 2008 issue of the Journal of the American Society Nephrology (JASN).
More Kidney Transplant News Articles
 | Dropsy, Dialysis, Transplant: A Short History of Failing Kidneys (Johns Hopkins Biographies of Disease) by Steven J. Peitzman Small and bean shaped, the kidneys are sophisticated organs that filter waste from the blood. A number of diseases and disorders -- including diabetes and hypertension -- can harm the kidneys and cause them to fail.Historian and nephrologist Steven J. Peitzman traces the medical history of kidney disease alongside the personal experience of illness. Drawing on diaries, letters, literary... |
 | Kidney Transplantation: Principles and Practice by Peter Morris, Stuart J. Knechtle Updated to reflect todays practice guidelines, the new edition of this comprehensive text remains the definitive resource on all aspects of renal transplantation, including immunological, pathological, psychological and ethical considerations. It examines evaluation, management, and procurement of living and deceased donor kidneys, the selection of suitable recipients, interpretation of graft... |
 | Handbook of Renal Biopsy Pathology by Alexander J. Howie This handbook provides a short, clear, useful and interesting guide to the findings in renal biopsy specimens. It is intended to be of practical help primarily to pathologists and trainee pathologists who look at these specimens, but also to nephrologists and transplant surgeons and their trainees, medical students, and others who have contact with anyone with renal disorders, including nurses on... |
 | Manual of Kidney Transplant Medical Care (Transplant Care Series) by Arthur J. Matas Written for health care practitioners who care for kidney transplant patients but who are not necessarily experts in transplant... |
 | A Gift of Life: A Page From the Life of a Living Organ Donor by Lynn Chabot-Long This is the extraordinary story of an ordinary family caught in a life or death struggle to save one of their own. With the possibility of a sibling becoming a living organ donor, this courageous family had to face the fact that they could lose not one, but two members. This story is told in a light hearted, yet no-holds-barred manner. During the process of becoming a donor, the author ... |
 | Kidney for Sale by Owner: Human Organs, Transplantation, and the Mark by Mark, J Cherry During the past ten years over 4,600 people have died annually in the United States while waiting for organ transplants. In 2003, 83,000 patients waited for transplantation--but only 20,000 patients received them. While everyone seems to agree that this is a national tragedy, bold initiatives to address the problem--such as creating a fee-based and regulated market for organ transplantation--have... |
 | A Fragile Life: The Epic of a Multiple Kidney Transplant Recipient by Guy M. Hollingsworth A Fragile Life: The Epic of a Multiple Kidney Transplant Recipient is an in-depth effort to understand living with a chronic illness (specifically kidney disease) as perceived by a woman who is a wife and a mother, covering the years from 1982 to 2005, and her efforts to address challenges associated with this illness.Christine has weathered multiple losses over a 23-year period due to kidney... |
 | The Roller Coaster Decade by Livia Moser The Roller Coaster Decade is an autobiography of 10 years of my life which begins when I was eighteen years old. I like all other high school graduates had plans for my life, but sometimes life just doesn't work out that way. I was diagnosed with bipolar illness and put into a mental facility in Switzerland, therefore having to postpone... |
 | Handbook of Kidney Transplantation A practical overview of renal transplantation for physicians who manage transplant patients as well as nurses and other professionals on the transplant team. The Second Edition has been thoroughly revised with completely up-to-date coverage of topics such as immunosuppressive drugs, short- and long-term post-transplant management and complications, and ethical/legal... |
 | Perfect Match: A Kidney Transplant Reveals the Ultimate Second Chance by Janet Hermans |
| © 2008 BrightSurf.com |