ST. LOUIS - America's obesity epidemic has not spared patients hoping for a new, life-saving kidney.
Now researchers at St. Louis University have found obese patients who receive a kidney transplant are at a higher risk for complications during recovery, prompting questions about how, and perhaps if, doctors should proceed with operations on patients with high body mass.
One-third of American adults are obese, meaning that they are at least 20 percent above normal weight. Obese people are at a higher risk for heart disease, stroke, diabetes and spend about $1,500 more a year on medical costs than people of normal weight, according to the Centers for Disease Control and Prevention.
"The prevalence of obesity among transplant recipients has increased in the last decade from 23 percent to 33 percent now," said Dr. Krista Lentine, associate professor of internal medicine in nephrology at SLU. "This includes 10 percent who are classified as morbidly obese."
Her article, published in the American Journal of Nephrology, concluded bigger transplant patients experience worse health outcomes, including wound infections, graft failure, cardiac disease and increased costs.
The nation's rising level of BMI -- a proxy for measuring body fat as a function of weight and height -- has led to more high-risk operations.
The study's recommendation: when possible, doctor-approved diet and exercise before surgery.
Doctors would require a patient with alcoholic liver disease to quit drinking before getting a new organ, but to what extent is obesity more about public health than personal fitness?
Dr. Jeffrey Lowell, a transplant surgeon at Barnes-Jewish Hospital, said that while he has seen the number of obese patients with renal failure increase, the study at SLU neglects the larger health dilemma.
Losing weight, Lowell says, is especially hard for people in a poorer demographic unable to rely on personal trainers and surrounded by fast food chains. "These are very complicated societal problems," he said.
Lentine believes her research, which focuses on health outcomes and gaps in the current body of literature, will set a framework for transplant centers evaluating obese patients, helping them select the safest treatment method.
"Transplant is a life-saving and life-altering procedure," said Dr. Betsy Tuttle-Newhall, director of abdominal transplant at SLU and a co-author of the study. "In order to prepare yourself to have the best possible outcome, you need to be in as good a shape as you can before you come into it. For those patients who are able, a good diet, good exercise and a healthy weight can facilitate their recovery."
But Lowell said that many people who are sick, obese and on dialysis simply do not have the time or the tools to lose weight before surgery.
In a 2008 study, researchers at Johns Hopkins University found that obese patients waited longer for kidney transplants compared with their non-obese counterparts. They were also more likely to be "bypassed" when a new kidney became available.
Transplant remains the preferred method for most patients with renal failure, obese or otherwise.
"Dialysis is not a way of life, it's a therapy. I suspect at some point if you get to the break point where complications in obesity outweigh the benefits of transplant, that's where the limits are going to have to be set," Tuttle-Newhall said. "I don't think anyone knows where that is yet."
On the kidney donor side, a health condition such as obesity can rule a person out for the elective surgery.
Doctors used to require a BMI of less than 30 for living donors, but Lentine said the threshold has since been raised to 35.
"There is a consensus that 35 for donors -- that's morbid obesity -- is acceptable if they have excellent other health," she said. "I've seen ones that are like '36, 37, can't you approve it?' No, you can't. They've got to lose it."
Last year, doctors at Health System Transplant Center on Long Island, N.Y., conducted an analysis of 104 potential living kidney donors seen from 2008 to 2011. Almost a quarter were not allowed to donate organs because they had a BMI of 35 or above.
"There would have to be extraordinary reasons to use a living donor with any health problems," Lowell said. "Their protections are hard-wired into the process."
As waistlines grow, 93,000 people remain on the kidney transplant wait list.
Lowell called the obesity epidemic a public health issue and hopes the study at SLU will spark citywide and not just patient-doctor solutions.
He said that schools should remove sugared drinks and incorporate more exercise. "It's not an easy solution. It's way more complicated than saying, 'OK go home and lose weight,'" Lowell said.
"We've made good progress on smoking. We will start seeing the benefits of that in a few years, like New York City has," Lowell said. "I put this in that category. I think this is an opportunity here in St. Louis to talk about big solutions." ___
Copyright 2013 MedCity News. All rights reserved. This material may not be published, broadcast, rewritten or redistributed. Source: http://medcitynews.com/2013/02/kidney-transplants-riskier-for-obese-patients/
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