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Incidence of conversion to active waitlist status among temporarily inactive obese renal transplant candidates.
- Source :
-
Transplantation [Transplantation] 2014 Jul 27; Vol. 98 (2), pp. 177-86. - Publication Year :
- 2014
-
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.<br />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.<br />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%.<br />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.
- Subjects :
- Adult
Body Mass Index
Comorbidity
Female
Healthcare Disparities
Humans
Kidney Failure, Chronic diagnosis
Kidney Failure, Chronic mortality
Male
Middle Aged
Obesity diagnosis
Obesity mortality
Patient Selection
Registries
Residence Characteristics
Retrospective Studies
Risk Assessment
Risk Factors
Severity of Illness Index
Time Factors
United States
Kidney Failure, Chronic epidemiology
Kidney Failure, Chronic surgery
Kidney Transplantation adverse effects
Kidney Transplantation mortality
Obesity epidemiology
Waiting Lists mortality
Subjects
Details
- Language :
- English
- ISSN :
- 1534-6080
- Volume :
- 98
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Transplantation
- Publication Type :
- Academic Journal
- Accession number :
- 24608735
- Full Text :
- https://doi.org/10.1097/TP.0000000000000037