284 - Body Mass as a Barrier to Pediatric Kidney Transplantation

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 284
Publication Number: 284.252

Rachel M. Engen, University of Wisconsin Madison, Madison, WI, United States; Marc Lande, Golisano Children's Hospital at The University of Rochester Medical Center, Rochester, NY, United States; Jodi Smith, University of Washington School of Medicine, Seattle, WA, United States; Sharon M. Bartosh, University of Wisconsin, Madison, WI, United States

Presenting Author(s)

RE

Rachel M. Engen, MD, MS

Assistant Professor
University of Wisconsin Madison
Madison, Wisconsin, United States

Background:

Obesity is associated with an increased risk of surgical site infection, delayed graft function, acute rejection, and graft loss after kidney transplantation in adult and pediatric recipients. A survey by the American Society of Transplantation showed that 66 out of 67 responding centers used a body mass index (BMI) of 35-45 kg/m² as a cutoff for listing for adult kidney transplant. There is limited data on such cutoffs for pediatric patients.

Objective:

Assess practice patterns regarding BMI requirements for listing of pediatric kidney transplant candidates

Design/Methods:

This is an exploratory survey conducted October to December 2022 among members of the Pediatric Nephrology Research Consortium and the American Society of Pediatric Nephrology. Members were asked about (1) the inclusion of BMI in their centers' written transplant listing criteria, (2) the number of candidates declined for listing or activation due to their BMI between 1/1/2016 and 12/31/2021, and (3) outcomes of patients declined for listing/activation, when possible.

Results:

Thirty-nine centers (30%) responded. Among these centers 21 (54%) reported including BMI in their listing criteria; median BMI threshold was 40 kg/m² (range 35-50 kg/m²). Between 1/1/2016 and 12/31/2021, 29 children at 16 centers were declined for active listing due to their BMI. Patient-level data was made available for 10 of these patients. Median age was 16.5 years (range 15-20). Median BMI was 45.7 kg/m² (range 38.4-49.4 kg/m²). Eight children (80%) were on dialysis either at the time they were initially evaluated for transplant or later. One year after the initial, declined evaluation, 2 patients had medical weight loss and one patient had surgical weight loss; all three were made active on the wait list and were subsequently transplanted. Median BMI at transplant was 35.4 kg/m². Five patients were listed in inactive status, and 2 remained unlisted and on dialysis.

Conclusion(s): Practice relating to in the use of BMI in evaluation vary among pediatric kidney transplant centers. More data related to outcomes of obese pediatric kidney transplant candidates who have been declined access to transplant is needed to guide institutional evaluation policies and management strategies.