Background:

Although lower rates of patient and graft survival are reported for kidney transplant recipients with BMI > 35, kidney transplant in this group provides a significant survival benefit when compared to patients with lower BMI maintained on dialysis. Despite these findings, BMI > 35 is associated with decreased access to kidney transplant, with the likelihood of receiving a transplant decreasing, when the degree of obesity increases. The extent of BMI restriction among transplant centers in the United States is not currently known. Appraisal of BMI restrictions among these centers can help to identify whether a disparity in access to kidney transplant exists for obese patients with BMI >35.

Methods:

An electronic Qualtrics survey was used to assess demographic characteristics of U.S. transplant centers including: BMI restriction (recipient and donor), % of Black patients, center size, and number of transplant each year. The survey consisted of seven multiple-choice, and one Likert scale response question, that assessed opinions regarding the importance of donor and recipient BMI when determining suitability for transplant. The survey was completed by transplant coordinators in approximately 60 seconds. All data was collected electronically and maintained on the Qualtrics site.

Results:

Overall response rate was 50% (N=35). Most (N=19, 54%) reporting centers performed 50-100 (N=15) and 100-150 (N=4) kidney transplants annually. 32 (91%) restricted BMI to <35 for kidney transplant donors. 13 (37%) centers had restrictions on kidney transplant for recipients with BMI >35, while 17 (49%) centers had restrictions for recipients with BMI > 40. Seventy one percent (N=25) of these centers indicated that 25-50% (N= 10) or 50% (N= 15) of their recipients are Black. Program size was variable in these groups. Only one center restricted kidney transplant to recipients with BMI < 30. Almost all respondents (N= 30, 86%) reported some level of agreement that BMI is an important consideration when determining suitability for kidney transplant.

Conclusion:

Restrictions on BMI for kidney transplant recipients and donors existed at all but one center participating in the survey. Centers having a moderate to large percentage of Black recipients placed a priori restrictions on kidney transplant for patients with BMI > 40. Importantly, although research findings do not support arbitrary restrictions on kidney transplant in patients with BMI > 35, most respondents supported these restrictions.

CITATION INFORMATION: Walczak D., Benedetti E., Ryan C. Is BMI > 35 a Barrier to Kidney Transplantation? Am J Transplant. 2017;17 (suppl 3).

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