Friday, September 20, 2013

IN the NEWS: Obesity and organ donation

Obese uremic patients might be the next wave of patients that nephrologists will face. A recent editorial in NDT highlights this epidemic that we are starting to see. Transplantation becomes a challenge in that setting as well. But what about donors? Where is the cut off and what are centers doing?

A recent study published in Clin Transplantation presents their data on a single center looking at obese donors. Of the 104 donors that the center evaluated in that time frame, only 18% had a normal body mass index (BMI) of <25.  Over 80% of the donors spanned the overweight to morbidly obese classifications. There were a total of 23 donors (22%) who were considered moderately and morbidly obese (BMI >35).
Of these, only three (13%) succeeded at losing weight and donating.

Some key points:
1. Only 18% had normal BMI!!!! ( hence most donors are in the overweight to obese spectrum)
2. Cut off for BMI at many centers vary, some have 35 for donors and some have 30( which would turn away even more donors)
3.Given national trend of obesity, this is going to get even more worrisome.
4.Follow ups: Six-month follow-up of obese donors post donation
did not show a significant difference  between obese donors and their non-obese counterparts
with respect to estimated glomerular filtration rate or creatinine from baseline in one study.
5.Another study showed that obesity at the time of donation was associated with dyslipidemia and hypertension, two important cardiovascular risk factors, although they were not found to be exacerbated by donation.
6.Obesity may be a frequent barrier to living kidney donation, directly leading to exclusion as a potential kidney donor in about one in five instances. Successful weight loss leading to donation appears to be infrequent, suggesting need to address obesity in the donor population.

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