Edmund Huang1, Michael Shye, David Elashoff, Alireza Mehrnia, Suphamai Bunnapradist. 1. 1 Division of Nephrology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA. 2 Department of Biostatistics, School of Public Health, University of California, Los Angeles, CA. 3 Address correspondence to: Edmund Huang, M.D., Kidney Transplant Research Program, UCLA David Geffen School of Medicine, 1033 Gayley Avenue, Suite 208, Los Angeles, CA 90095.
Abstract
BACKGROUND: Candidates may be active or temporarily inactive (status 7) on the kidney transplant waiting list. One reason candidates may be inactive is for a "weight currently inappropriate for transplantation." We hypothesized that many of these candidates would not achieve active status. METHODS: Using OPTN/UNOS data from 2006 to 2012, we used competing risks methods to determine the cumulative incidence of conversion to active status (activation), death, and delisting before conversion among 1679 obese adult kidney candidates designated as status 7 because of a weight inappropriate for transplantation. Fine and Gray competing risks regression was performed to characterize factors associated with conversion to active status in the overall study population and of transplantation among a subgroup of activated candidates. RESULTS: At 6 years, the cumulative incidence of activation was 49%, of death before conversion was 15%, and of delisting was 21%. Higher body mass index (BMI) was strongly associated with a decreased subhazard of activation (BMI ≥45 versus 30-34.9, sHR: 0.22; 95% CI, 0.16-0.33). Female sex, diabetic end-stage renal disease, history of a previous transplant, panel reactive antibodies less than 80%, dialysis dependence at listing, and UNOS region 5 were negatively associated with activation. Among activated candidates, the cumulative incidence of transplantation at 6 years after initial waitlisting was 61%. CONCLUSION: Our findings indicate that half of obese status 7 candidates with a weight inappropriate for transplantation will not achieve active waitlist status. BMI at listing had a strong association with conversion to active status; comorbid factors and regional variation also impact activation.
BACKGROUND: Candidates may be active or temporarily inactive (status 7) on the kidney transplant waiting list. One reason candidates may be inactive is for a "weight currently inappropriate for transplantation." We hypothesized that many of these candidates would not achieve active status. METHODS: Using OPTN/UNOS data from 2006 to 2012, we used competing risks methods to determine the cumulative incidence of conversion to active status (activation), death, and delisting before conversion among 1679 obese adult kidney candidates designated as status 7 because of a weight inappropriate for transplantation. Fine and Gray competing risks regression was performed to characterize factors associated with conversion to active status in the overall study population and of transplantation among a subgroup of activated candidates. RESULTS: At 6 years, the cumulative incidence of activation was 49%, of death before conversion was 15%, and of delisting was 21%. Higher body mass index (BMI) was strongly associated with a decreased subhazard of activation (BMI ≥45 versus 30-34.9, sHR: 0.22; 95% CI, 0.16-0.33). Female sex, diabetic end-stage renal disease, history of a previous transplant, panel reactive antibodies less than 80%, dialysis dependence at listing, and UNOS region 5 were negatively associated with activation. Among activated candidates, the cumulative incidence of transplantation at 6 years after initial waitlisting was 61%. CONCLUSION: Our findings indicate that half of obese status 7 candidates with a weight inappropriate for transplantation will not achieve active waitlist status. BMI at listing had a strong association with conversion to active status; comorbid factors and regional variation also impact activation.
Authors: Cory R Schaffhausen; Marilyn J Bruin; Warren T McKinney; Jon J Snyder; Arthur J Matas; Bertram L Kasiske; Ajay K Israni Journal: Clin Transplant Date: 2019-04-21 Impact factor: 2.863
Authors: Jesse D Schold; Joshua J Augustine; Anne M Huml; Richard Fatica; Saul Nurko; Alvin Wee; Emilio D Poggio Journal: Am J Transplant Date: 2020-08-27 Impact factor: 8.086
Authors: Efrain Talamantes; Keith C Norris; Carol M Mangione; Gerardo Moreno; Amy D Waterman; John D Peipert; Suphamai Bunnapradist; Edmund Huang Journal: Clin J Am Soc Nephrol Date: 2017-02-09 Impact factor: 10.614