 |
|
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 Current Events and Kidney Transplant News RSSHigh Blood Pressure Easy to Miss in Children with Kidney Disease
Spot blood pressure readings in children with chronic kidney disease often fail to detect hypertension - even during doctor's office visits - increasing a child's risk for serious heart problems, according to research from Johns Hopkins Children's Center and other institutions. A report of the findings appears online in the Journal of American Society of Nephrology.
Switching immunosuppressants reduces cancer risk in kidney
Switching to a newer type of immunosuppressant drug may reduce the high rate of skin cancer after kidney transplantation, according to research being presented at the American Society of Nephrology's 42nd Annual Meeting and Scientific Exposition in San Diego, CA.
Kidney transplants generally safe for lupus patients
Individuals with a history of lupus who receive a kidney transplant rarely develop the serious inflammatory condition lupus nephritis in their new organ, according to a paper being presented at the American Society of Nephrology's 42nd Annual Meeting and Scientific Exposition in San Diego, CA.
Kidneys from deceased donors with acute renal failure expand donor pool
Kidneys recovered from deceased donors with acute renal failure (ARF) - once deemed unusable for transplant - appear to work just as well as kidneys transplanted from deceased donors who do not develop kidney problems prior to organ donation.
Link between depression, early stages of chronic kidney disease found by researchers
One in five patients with chronic kidney disease is depressed, even before beginning long-term dialysis therapy or developing end-stage renal disease, UT Southwestern Medical Center researchers have found.
New Discovery Brings Hope to Treatment of Lymphatic Diseases
Researchers in the laboratory of Dr. Jayakrishna Ambati at the University of Kentucky have discovered the first naturally occurring molecule that selectively blocks lymphatic vessel growth.
Mars and Venus: Short- and long-term success of male to female kidney transplants
Female recipients of kidneys from deceased male donors demonstrate an increased risk of allograft failure in the first year after transplant, but show no increased risk after ten years.
Post-transplant combo can replace toxic immune-suppressing drugs in monkeys
Transplant patients rely on drugs to prevent graft rejection, but at the cost of serious side effects.
Johns Hopkins leads first 16-patient, multicenter 'domino donor' kidney transplant
Surgical teams at The Johns Hopkins Hospital, Barnes-Jewish Hospital in St. Louis, INTEGRIS Baptist Medical Center in Oklahoma City and Henry Ford Hospital in Detroit successfully completed the first eight-way, multihospital, domino kidney transplant.
Microscopic 'beads' could help create 'designer' immune cells that ignore transplanted organs
The future of organ transplantation could include microscopic beads that create "designer" immune cells to help patients tolerate their new organ, Medical College of Georgia researchers say.
More Kidney Transplant Current Events and Kidney Transplant News Articles
 |
Kidney Transplantation: Principles and Practice (Morris,Kidney Transplantation) by Peter Morris AC FRS FRCS (Author), Stuart J. Knechtle MD (Author) Updated to reflect today's 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 dysfunction, and expected survival based upon a large database of information. There are comprehensive chapters on pediatric renal transplantation and on renal transplantation in the developing world. Extensive tables and figures and comprehensive lists of references with each chapter enhance its value to the transplant team. A multidisciplinary approach from internationally renowned contributors... |
 |
Kidney Transplants Explained by Andy Stein (Author) This book offers coverage of the important topics such as the 'postcode lottery', organ allocation and deceased and living donor organs. It provides practical information about the operation, medication and the first three months after transplant. It offers post-transplant advice: how to look after yourself and your new kidney. Real life accounts of people who have experienced the issues are discussed. All the 'Key Facts' are summarised at the end of each chapter. |
 |
Perfect Match: A Kidney Transplant Reveals the Ultimate Second Chance by Janet Hermans (Author) |
 |
Manual of Kidney Transplant Medical Care (Transplant Care Series) by Arthur J. Matas (Author) Written for health care practitioners who care for pre- or post-operative kidney transplant recipients but who are not necessarily experts in transplant medicine. Explains common medical problems experienced by transplant recipients, factors to consider when prescribing medications, etc. |
 |
Handbook of Kidney Transplantation, Fourth edition by Gabriel M Danovitch (Editor) Now in its updated Fourth Edition, this popular handbook is a practical guide for physicians and surgeons who manage kidney transplant patients and for nurses and other professionals on the transplant team. In concise, readable, well-illustrated chapters, the book outlines the major concerns surrounding renal transplantation and the most successful approaches to problems arising in short-term and long-term patient care. This edition's chapters on immunobiology and immunosuppression have been completely rewritten to reflect recent advances. Chapters on surgery, histocompatibility, and the first three months post-transplant have also been thoroughly updated. "Doody's Core TitlesTM 2009." |
 |
Kidney Transplant Survivor Kids Light T-Shirt by CafePress |
 |
Dropsy, Dialysis, Transplant: A Short History of Failing Kidneys (Johns Hopkins Biographies of Disease) by Steven J. Peitzman (Author) 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 narratives, and scientific writings, Peitzman charts the triumphs of medical innovators like Richard Bright, Thomas Addis, and Belding Scribner as well as the stories of persons, famous and not, who have struggled with the disease. Conditions once known as "Bright's Disease" are now recognized as complex disorders with names such as glomerulopathy and acute tubular necrosis. Treatments... |
 |
Surgeons Conduct a Kidney Transplant Photographic Poster Print by Jodi Cobb, 24x18 by Art.com Art.com is the world's largest retailer of art prints, posters, photographs, and framed artwork. With our huge selection of over 400,000 prints, you'll easily find the perfect piece for your home, office, or classroom. Our art is printed on quality paper. When you order framed artwork, the piece is built by our team of in-house professionals. Visit our Amazon store today at www.amazon.com/artdotcom to find Special Offers and search for products based on 'Artist Name' and 'Subject Categories' such as Movie, Music, Vintage, TV, Children, Travel, Kitchen, Museum Art, Animals, Floral, Motivational, and Sports. Art.com is dedicated to providing you with high quality products and service by offering you 100% satisfaction guaranteed. We ship internationally to over 80 countries. Decorate your... |
 |
Kidney Transplant Survivor Infant/Toddler T-Shirt by CafePress |
 |
Organ Transplant: Making a Match (Home Use) Part of the award winning public television series Healthy Body/Healthy Mind. About sixty years ago, successful organ transplants for humans began to show signs of success. Since then, organ transplants have saved millions of lives worldwide. More than 65,000 Americans are waiting for an organ transplant. While each day about 57 Americans receive a transplant, about 13 will die because not enough organs are available. Once a transplant has been completed, preventing the body's rejection of the transplanted organ can be an ongoing challenge. The body's attempt to destroy the transplanted organ; usually occurs in the first year after transplant. Rejection occurs when the body tries to attack a transplanted organ because it reacts to the organ or tissue as a foreign object and produces... |
| © 2009 BrightSurf.com |