Kidney Week

Abstract: TH-OR123

Association of Pre-Transplant Weight Loss with Mortality after Deceased Donor Kidney Transplantation

Session Information

• Predictors of Clinical Outcomes After Kidney Transplantation
  October 25, 2018 | Location: 6C, San Diego Convention Center
  Abstract Time: 04:54 PM - 05:06 PM

Category: Transplantation

• 1802 Transplantation: Clinical

Authors

• Harhay, Meera Nair, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States

Meera Nair Harhay, MD, MS, FASN



Dr. Meera Nair Harhay, MD MSCE FASN is a transplant nephrologist and epidemiologist. She is an Associate Professor of Medicine at the Drexel University College of Medicine in Philadelphia, Pennsylvania. Her research on the physical and cognitive trajectories of kidney transplant candidates is supported by a career development award from the National Institutes of Health.

• Boyle, Suzanne, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States

Suzanne Boyle,

• Ranganna, Karthik M., Drexel University College of Medicine, Philadelphia, Pennsylvania, United States

Karthik M. Ranganna,

• McAdams-DeMarco, Mara, Johns Hopkins, Baltimore, Maryland, United States

Mara McAdams-DeMarco,

Background

Weight loss is a recognized component of frailty, signaling vulnerability to health stressors. Whether deceased donor kidney transplant (DDKT) recipients who lost weight before DDKT are at higher risk of adverse post-transplant outcomes is unknown.

Methods

Retrospective cohort study, using national registry data, of all DDKT recipients in the United States between January 1, 2005 and December 31, 2014 who were adults (age>=18 years) at wait-listing. We used unadjusted fractional polynomial methods and adjusted Cox proportional hazards models to examine the association of relative change in body weight pre-DDKT with post-DDKT mortality.

Results

Among 96,938 DDKT recipients, there was a non-linear unadjusted relationship between relative pre-DDKT weight change and post-DDKT mortality, with a steep increase in mortality among DDKT recipients who lost 10% or more of their listing body weight compared to those with no pre-DDKT weight change (Figure). In a multivariable Cox model adjusted for recipient and allograft characteristics, waiting time, and dialysis vintage, compared to recipients with weights at DDKT within 5% of their listing weights, recipients who lost 10% or more of their listing body weight before DDKT were 14% more likely to die post-DDKT (adjusted hazard ratio 1.14, 95% confidence interval 1.08-1.21, p<0.001). Pre-DDKT weight gain was not independently associated with post-DDKT mortality after multivariable adjustment. There was no evidence of effect modification by age, dialysis vintage, or body mass index (p>0.10 for interaction terms).

Conclusion

Substantial weight loss before DDKT may indicate increased vulnerability after DDKT. Studies are needed to identify and modify unhealthy weight trajectories among DDKT candidates.

Figure demonstrates the distribution of pre-DDKT weight change (light green) among 96,938 DDKT recipients, and the unadjusted association of pre-DDKT weight change with post-DDKT mortality (black line) with 95% confidence intervals (light blue).

Funding

• NIDDK Support