May 20, 2022
About the Symposium on Obesity and Kidney Transplantation
Obesity is one of the most pressing public health issues in the United States. Forty-two percent of American adults are obese, defined by a body mass index (BMI) greater than or equal to 30 kg/m and another third are overweight, leaving them at risk for the development of obesity, as well as weight-related health problems. Specifically, obesity increases the risk of hypertension and type 2 diabetes, the two leading causes of kidney disease in the U.S., and more than 90 percent of individuals who are overweight or obese have type 2 diabetes [1, 2]. Thus, obesity and kidney disease are inextricably linked, with obesity having a direct effect on kidney disease outcomes and progression.
The average BMI of patients with ESKD and on dialysis has also increased exponentially in the past several years [3, 4]. Twenty-four percent of kidney transplant candidates on the waiting list in the U.S. meet the criteria for class 1 obesity (defined as BMI of 30 to < 35 kg/m2) and more than 14 percent meet the criteria for classes 2 or 3 obesity (defined as BMI of 35 to < 40 kg/m2 and >= 40, respectively . Paradoxically, obesity has been associated with increased survival for patients receiving dialysis [6-8]. Once transplanted, however, some research suggests that patients with obesity have inferior clinical outcomes, including decreased patient survival, delayed graft function, poor wound adhesion, increased graft failure, and an increased risk of diabetes and cardiac disease, compared to patients without obesity [9-21]. Consequently, some patients with obesity are denied kidney transplantation or delayed until weight loss has been achieved due to a perceived increased risk of poor outcomes . Conversely, although some immediate postoperative outcomes are inferior, kidney transplant recipients with obesity have comparable long-term outcomes to those without obesity [13, 16, 23]. Further, kidney transplantation in patients with obesity has been shown to provide a survival benefit compared to long-term dialysis [3, 13, 19, 24], with one study finding that the mortality rate for patients with obesity who underwent transplantation was half that of those remaining on the wait list .
The Symposium on Obesity and Kidney Transplantation will bring researchers, clinicians, allied health professionals and patients together to review and discuss the current state of knowledge regarding obesity and kidney transplantation and generate a research agenda, with specific research questions, informed by patients’ lived experience. Specifically, the conference aims to provide a forum to review and discuss the current state of knowledge and generate:
- A position statement to inform policy and practice regarding patient selection for kidney transplantation, and access to transplantation for growing numbers of patients with end-stage kidney disease and obesity, most of whom are low-income, racial/ethnic minorities.
- A research agenda, with specific research questions.
2. Centers for Disease Control and Prevention. Obesity & Overweight. Data & Statistics. https://www.cdc.gov/obesity/data/index.html
3. Johansen KL. Obesity and body composition for transplant wait-list candidacy – challenging or maintaining the BMI limits? J Ren Nutr. 2013;23(3):207–9. PMID: 236115484. Kramer HJ. Increasing body mass index and obesity in the incident ESRD population. J Am Soc Neph. 2006;17(5):1453–59. PMID: 16597682
5. US Renal Data System 2019 Annual Data Report: Epidemiology of Kidney Disease in the United States. Executive Summary. Bethesda, MD; 2020. https://www.usrds.org/2019/view/USRDS_2019_ES_final.pdf
6. Park J, Ahmadi S-F, Streja E, Molnar MZ, Flegal KM, Gillen D, Kovesdy CP, Kalantar-Zadeh K. Obesity paradox in end-stage kidney disease patients. Prog Cardiovasc Dis. 2014;56(4):415-25. PMID: 24438733
7. Vashistha T, Mehrotra R, Park J, Streja E, Dukkipati R, Nissenson AR, Ma JZ, Kovesdy CP, Kalantar-Zadeh K. Effect of age and dialysis vintage on obesity paradox in long-term hemodialysis patients. Am J Kidney Dis. 2014;63(4):612-22. PMID: 24120224
8. Kalantar-Zadeh K, Rhee CM, Chou J, Ahmadi SF, Park J, Chen JL, Amin AN. The obesity paradox in kidney disease: how to reconcile it with obesity management. Kidney Int Rep. 2017;271-81. PMID: 28439569
9. Curran SP, Famure O, Li Y, Kim SJ. Increased recipient body mass index is associated with acute rejection and other adverse outcomes after kidney transplantation. Transplantation. 2014;97(1):64–70. PMID: 24056619
10. Furriel F, Parada B, Campos L, Moreira P, Castelo D, Dias V, Mota A. Pretransplantation overweight and obesity: Does it really affect kidney transplantation outcomes? Transplant Proc. 2011;43(1):95–99. PMID: 21335163
11. Gore JL, Pham PT, Danovitch GM, Wilkinson AH, Rosenthal JT, Lipshutz GS, Singer JS. Obesity and outcome following renal transplantation. Am J Transplant. 2006;6(2):357–63. PMID: 16426321
12. Molnar MZ, Kovesdy CP, Mucsi I, Bunnapradist S, Streja E, Krishnan M, Kalantar-Zadeh K. Higher recipient body mass index is associated with post-transplant delayed kidney graft function. Kidney Int. 2011;80(2):218–24. PMID: 21525853
13. Bennett WM, Mcevoy KM, Henell KR, Pidikiti S, Douzdjian V, Batiuk T. Kidney transplantation in the morbidly obese: Complicated but still better than dialysis. Clin Transplant. 2011;25(3):401–5. PMID: 20946469
14. Johnson DW, Isbel NM, Brown AM, Kay TD, Franzen K, Hawley CM, Campbell SB, Wall D, Griffin A, Nicol DL. The effect of obesity on renal transplant outcomes. Transplantation. 2002;74(5):675–81. PMID: 12352885
15. Lafranca JA, IJermans JNM, Betjes MGH, Dor FJMF. Body mass index and outcome in renal transplant recipients: a systematic review and meta-analysis. BMC Med. 2015;13:111. PMID: 25963131
16. Lynch RJ, Ranney DN, Shijie C, Lee DS, Samala N, Englesbe MJ. Obesity, surgical site infection, and outcome following renal transplantation. Ann Surg. 2009;250(6):1014–20. PMID: 19779327
17. Marks WH, Florence LS, Chapman PH, Precht AF, Perkinson DT. Morbid obesity is not a contraindication to kidney transplantation. Am J Surg. 2004;187(5):635–38. PMID: 15135681
18. Singh D, Lawen J, Alkhudair W. Does pretransplant obesity affect the outcome in kidney transplant recipients? Transplant Proc. 2005;37(2):717–20. PMID: 15848512
19. Naik AS, Sakhuja A, Cibrik DM, Ojo AO, Samaniego-Picota MD, Lentine KL. The impact of obesity on allograft failure after kidney transplantation: A competing risks analysis. Transplantation. 2016;100(9): 1963–169. PMID: 26569067
20. Gusukuma LW, Harada KM, Baptista APM, Alencar MRP, De Sandes-Freitas TV, Tedesco-Silva H, Medina-Pestana JO. Outcomes in obese kidney transplant recipients. Transplant Proc. 2014;46(10); 3416–3419. PMID: 25498063
21. Lentine KL, Rocca-Rey LA, Bacchi G, Wasi N, Schmitz L, Salvalaggio PR, Abbott KC, Schnitzler MA, Neri L, Brennan D. Obesity and cardiac risk after kidney transplantation: experience at one center and comprehensive literature review. Transplantation. 2008;86(2):303–312. PMID: 18645495
22. Huang E, Shye M, Elashoff D, Mehrnia A, Bunnapradist S. Incidence of conversion to active waitlist status among temporarily inactive obese renal transplant candidates. Transplantation. 2014;98(2):177-186. PMID: 24608735
23. Ditonno P, Lucarelli G, Impedovo SV, Spilotros M, Grandaliano G, Selvaggi FP, Bettocchi C, Battaglia M. Obesity in kidney transplantation affects renal function but not graft and patient survival. Transplant Proc. 2011;43(1):367–372. PMID: 21335224
24. Gill JS, Lan J, Dong J, Rose C, Hendren E, Johnston O, Gill JS. The survival benefit of kidney transplantation in obese patients. Am J Transplant. 2013;13(8):2083–90. PMID: 23890325
How to Participate
We have planned a hybrid meeting to facilitate both in-person and remote attendance and participation. For those attending in person, a continental breakfast will be provided, as well as lunch and a light reception following the event. For those who choose to attend in person, we will do everything possible to make this a safe event. The space accommodations allow for significant social distancing, and masks will be required when not actively eating, drinking, or speaking at the podium.
If the development of COVID requires a change in plans, we will communicate that as soon as possible. Please contact the event coordinator with any questions: email@example.com
Planning Committee Members
Heather Gardiner, PhD, MPH (Chair), Associate Professor and Director of the Office of Community Engaged Research and Practice, College of Public Health, Temple University
Serban Constaninescu, MD, PhD, Professor, Medicine, Lewis Katz School of Medicine, Temple University Hospital
Matthew Fasbinder, Patient Partner
Avrum Gillespie, MD, Associate Professor, Medicine, Lewis Katz School of Medicine, Temple University Hospital
Karen Greathouse, RD, Transplant Dietician, Chair of the Council of Renal Nutrition, University of Michigan Health System
Rohit Soans, MD, Associate Professor and Medical Director, Bariatric Surgery, Lewis Katz School of Medicine, Temple University Hospital
Colleen Tewksbury, PhD, MPH, RD, CSOWM, LDN, Bariatric Program Director, Penn Medicine
Megan Urbanski, MSW, PhD, Post-Doctoral Fellow, Department of Surgery, Emory University
Marielle Van Thuyne, Director Programs, National Kidney Foundation Serving Eastern Pennsylvania and New Jersey
Temple University – Medical Education and Research Building commons and attached auditorium (room 105), 3500 N. Broad St., Philadelphia, PA 19140.