Association Between Weight Loss Before Deceased Donor Kidney Transplantation and Posttransplantation Outcomes
There is debate on whether weight loss, a hallmark of frailty, signals higher risk for adverse outcomes among recipients of deceased donor kidney transplantation (DDKT). Retrospective cohort study. Using national Organ Procurement and Transplantation Network data, we included all DDKT recipients in...
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| Veröffentlicht in: | American journal of kidney diseases 2019-09, Vol.74 (3), p.361-372 |
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| creator | Harhay, Meera Nair Ranganna, Karthik Boyle, Suzanne M. Brown, Antonia M. Bajakian, Thalia Levin Mizrahi, Lissa B. Xiao, Gary Guy, Stephen Malat, Gregory Segev, Dorry L. Reich, David McAdams-DeMarco, Mara |
| description | There is debate on whether weight loss, a hallmark of frailty, signals higher risk for adverse outcomes among recipients of deceased donor kidney transplantation (DDKT).
Retrospective cohort study.
Using national Organ Procurement and Transplantation Network data, we included all DDKT recipients in the United States between December 4, 2004, and December 3, 2014, who were adults (aged ≥ 18 years) when listed for DDKT.
Relative pre-DDKT weight change as a continuous predictor and categorized as |
| doi_str_mv | 10.1053/j.ajkd.2019.03.418 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6708783</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0272638619306663</els_id><sourcerecordid>2232098321</sourcerecordid><originalsourceid>FETCH-LOGICAL-c455t-a4eeb808bb081221664a36aa337956bc9985167b0b197b960facee8c34749a193</originalsourceid><addsrcrecordid>eNp9kU1PGzEQhq2qqKTAH-ih2mMvu_hj12tLqBJfhYpIcAjiaHm9k8Rp1g62A-Lf11FoBD0wl5HG77wzngehbwRXBDfseFHpxZ--opjICrOqJuITGpGGspILJj6jEaYtLTkTfB99jXGBMZaM8y9onxFCeY4RGk5j9MbqZL0rziA9A7jiAexsnoqxjzHXpj5AcQEGdIS-uPDOh-LG9g5eiknQLq6W2qWtgXZ9cedjSv_Vb9fJ-AHiIdqb6mWEo9d8gO5_XU7Or8vx7dXv89NxaeqmSaWuATqBRddhQSglnNeaca0Za2XDOyOlaAhvO9wR2XaS46k2AMKwuq2lJpIdoJ9b39W6G6A34PJGS7UKdtDhRXlt1fsXZ-dq5p8Ub7FoBcsGP14Ngn9cQ0xqsNHAMn8J_DoqShnFUjBKspRupSbkewWY7sYQrDac1EJtOKkNJ4WZypxy0_e3C-5a_oHJgpOtAPKZniwEFY0FZ6C3AUxSvbcf-f8FimGmzg</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2232098321</pqid></control><display><type>article</type><title>Association Between Weight Loss Before Deceased Donor Kidney Transplantation and Posttransplantation Outcomes</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Harhay, Meera Nair ; Ranganna, Karthik ; Boyle, Suzanne M. ; Brown, Antonia M. ; Bajakian, Thalia ; Levin Mizrahi, Lissa B. ; Xiao, Gary ; Guy, Stephen ; Malat, Gregory ; Segev, Dorry L. ; Reich, David ; McAdams-DeMarco, Mara</creator><creatorcontrib>Harhay, Meera Nair ; Ranganna, Karthik ; Boyle, Suzanne M. ; Brown, Antonia M. ; Bajakian, Thalia ; Levin Mizrahi, Lissa B. ; Xiao, Gary ; Guy, Stephen ; Malat, Gregory ; Segev, Dorry L. ; Reich, David ; McAdams-DeMarco, Mara</creatorcontrib><description><![CDATA[There is debate on whether weight loss, a hallmark of frailty, signals higher risk for adverse outcomes among recipients of deceased donor kidney transplantation (DDKT).
Retrospective cohort study.
Using national Organ Procurement and Transplantation Network data, we included all DDKT recipients in the United States between December 4, 2004, and December 3, 2014, who were adults (aged ≥ 18 years) when listed for DDKT.
Relative pre-DDKT weight change as a continuous predictor and categorized as <5% weight change from listing to DDKT, ≥5% to <10% weight loss, ≥10% weight loss, ≥5% to <10% weight gain, and ≥10% weight gain.
We examined 3 post-DDKT outcomes: (1) transplant hospitalization length of stay (LOS) in days, (2) all-cause graft failure, and (3) mortality.
Unadjusted fractional polynomial methods, multivariable log-gamma models, and multivariable Cox proportional hazards models.
Among 94,465 recipients of DDKT, median pre-DDKT weight change was 0 (interquartile range, −3.5 to +3.9) kg. There were nonlinear unadjusted associations between relative pre-DDKT weight loss and longer transplant hospitalization LOS, higher all-cause graft loss, and higher mortality. Compared with recipients with <5% pre-DDKT weight change (n = 49,366; 52%), recipients who lost ≥10% of their listing weight (n = 10,614; 11%) had 0.66 (95% CI, 0.23-1.09) days longer average transplant hospitalization LOS (P = 0.003), 1.11-fold higher graft loss (adjusted HR [aHR], 1.11; 95% CI, 1.06-1.17; P < 0.001), and 1.18-fold higher mortality (aHR, 1.18; 95% CI, 1.11-1.25; P < 0.001) independent of recipient, donor, and transplant factors. Pre-DDKT dialysis exposure, listing body mass index category, and waiting time modified the association of pre-DDKT weight change with hospital LOS (interaction P < 0.10), but not with all-cause graft loss and mortality.
Unmeasured confounders and inability to identify volitional weight change. Also, the higher significance level set to increase the power of detecting interactions with the fixed sample size may have resulted in increased risk for type 1 error.
DDKT recipients with ≥10% pre-DDKT weight loss are at increased risk for adverse outcomes and may benefit from augmented support post-DDKT.]]></description><identifier>ISSN: 0272-6386</identifier><identifier>EISSN: 1523-6838</identifier><identifier>DOI: 10.1053/j.ajkd.2019.03.418</identifier><identifier>PMID: 31126666</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adolescent ; Adult ; Aged ; Cadaver ; Cohort Studies ; deceased donor kidney transplantation (DDKT) ; end-stage kidney disease (ESKD) ; Female ; frailty ; graft failure ; Humans ; Kidney Transplantation ; Male ; Middle Aged ; mortality ; obesity ; outcomes ; Postoperative Complications - epidemiology ; Preoperative Period ; protein-wasting malnutrition ; Renal transplantation ; Retrospective Studies ; Risk Factors ; sarcopenia ; Tissue Donors ; Treatment Outcome ; wasting ; Weight Loss ; Young Adult</subject><ispartof>American journal of kidney diseases, 2019-09, Vol.74 (3), p.361-372</ispartof><rights>2019 National Kidney Foundation, Inc.</rights><rights>Copyright © 2019 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c455t-a4eeb808bb081221664a36aa337956bc9985167b0b197b960facee8c34749a193</citedby><cites>FETCH-LOGICAL-c455t-a4eeb808bb081221664a36aa337956bc9985167b0b197b960facee8c34749a193</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1053/j.ajkd.2019.03.418$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3536,27903,27904,45974</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31126666$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Harhay, Meera Nair</creatorcontrib><creatorcontrib>Ranganna, Karthik</creatorcontrib><creatorcontrib>Boyle, Suzanne M.</creatorcontrib><creatorcontrib>Brown, Antonia M.</creatorcontrib><creatorcontrib>Bajakian, Thalia</creatorcontrib><creatorcontrib>Levin Mizrahi, Lissa B.</creatorcontrib><creatorcontrib>Xiao, Gary</creatorcontrib><creatorcontrib>Guy, Stephen</creatorcontrib><creatorcontrib>Malat, Gregory</creatorcontrib><creatorcontrib>Segev, Dorry L.</creatorcontrib><creatorcontrib>Reich, David</creatorcontrib><creatorcontrib>McAdams-DeMarco, Mara</creatorcontrib><title>Association Between Weight Loss Before Deceased Donor Kidney Transplantation and Posttransplantation Outcomes</title><title>American journal of kidney diseases</title><addtitle>Am J Kidney Dis</addtitle><description><![CDATA[There is debate on whether weight loss, a hallmark of frailty, signals higher risk for adverse outcomes among recipients of deceased donor kidney transplantation (DDKT).
Retrospective cohort study.
Using national Organ Procurement and Transplantation Network data, we included all DDKT recipients in the United States between December 4, 2004, and December 3, 2014, who were adults (aged ≥ 18 years) when listed for DDKT.
Relative pre-DDKT weight change as a continuous predictor and categorized as <5% weight change from listing to DDKT, ≥5% to <10% weight loss, ≥10% weight loss, ≥5% to <10% weight gain, and ≥10% weight gain.
We examined 3 post-DDKT outcomes: (1) transplant hospitalization length of stay (LOS) in days, (2) all-cause graft failure, and (3) mortality.
Unadjusted fractional polynomial methods, multivariable log-gamma models, and multivariable Cox proportional hazards models.
Among 94,465 recipients of DDKT, median pre-DDKT weight change was 0 (interquartile range, −3.5 to +3.9) kg. There were nonlinear unadjusted associations between relative pre-DDKT weight loss and longer transplant hospitalization LOS, higher all-cause graft loss, and higher mortality. Compared with recipients with <5% pre-DDKT weight change (n = 49,366; 52%), recipients who lost ≥10% of their listing weight (n = 10,614; 11%) had 0.66 (95% CI, 0.23-1.09) days longer average transplant hospitalization LOS (P = 0.003), 1.11-fold higher graft loss (adjusted HR [aHR], 1.11; 95% CI, 1.06-1.17; P < 0.001), and 1.18-fold higher mortality (aHR, 1.18; 95% CI, 1.11-1.25; P < 0.001) independent of recipient, donor, and transplant factors. Pre-DDKT dialysis exposure, listing body mass index category, and waiting time modified the association of pre-DDKT weight change with hospital LOS (interaction P < 0.10), but not with all-cause graft loss and mortality.
Unmeasured confounders and inability to identify volitional weight change. Also, the higher significance level set to increase the power of detecting interactions with the fixed sample size may have resulted in increased risk for type 1 error.
DDKT recipients with ≥10% pre-DDKT weight loss are at increased risk for adverse outcomes and may benefit from augmented support post-DDKT.]]></description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Cadaver</subject><subject>Cohort Studies</subject><subject>deceased donor kidney transplantation (DDKT)</subject><subject>end-stage kidney disease (ESKD)</subject><subject>Female</subject><subject>frailty</subject><subject>graft failure</subject><subject>Humans</subject><subject>Kidney Transplantation</subject><subject>Male</subject><subject>Middle Aged</subject><subject>mortality</subject><subject>obesity</subject><subject>outcomes</subject><subject>Postoperative Complications - epidemiology</subject><subject>Preoperative Period</subject><subject>protein-wasting malnutrition</subject><subject>Renal transplantation</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>sarcopenia</subject><subject>Tissue Donors</subject><subject>Treatment Outcome</subject><subject>wasting</subject><subject>Weight Loss</subject><subject>Young Adult</subject><issn>0272-6386</issn><issn>1523-6838</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU1PGzEQhq2qqKTAH-ih2mMvu_hj12tLqBJfhYpIcAjiaHm9k8Rp1g62A-Lf11FoBD0wl5HG77wzngehbwRXBDfseFHpxZ--opjICrOqJuITGpGGspILJj6jEaYtLTkTfB99jXGBMZaM8y9onxFCeY4RGk5j9MbqZL0rziA9A7jiAexsnoqxjzHXpj5AcQEGdIS-uPDOh-LG9g5eiknQLq6W2qWtgXZ9cedjSv_Vb9fJ-AHiIdqb6mWEo9d8gO5_XU7Or8vx7dXv89NxaeqmSaWuATqBRddhQSglnNeaca0Za2XDOyOlaAhvO9wR2XaS46k2AMKwuq2lJpIdoJ9b39W6G6A34PJGS7UKdtDhRXlt1fsXZ-dq5p8Ub7FoBcsGP14Ngn9cQ0xqsNHAMn8J_DoqShnFUjBKspRupSbkewWY7sYQrDac1EJtOKkNJ4WZypxy0_e3C-5a_oHJgpOtAPKZniwEFY0FZ6C3AUxSvbcf-f8FimGmzg</recordid><startdate>20190901</startdate><enddate>20190901</enddate><creator>Harhay, Meera Nair</creator><creator>Ranganna, Karthik</creator><creator>Boyle, Suzanne M.</creator><creator>Brown, Antonia M.</creator><creator>Bajakian, Thalia</creator><creator>Levin Mizrahi, Lissa B.</creator><creator>Xiao, Gary</creator><creator>Guy, Stephen</creator><creator>Malat, Gregory</creator><creator>Segev, Dorry L.</creator><creator>Reich, David</creator><creator>McAdams-DeMarco, Mara</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20190901</creationdate><title>Association Between Weight Loss Before Deceased Donor Kidney Transplantation and Posttransplantation Outcomes</title><author>Harhay, Meera Nair ; Ranganna, Karthik ; Boyle, Suzanne M. ; Brown, Antonia M. ; Bajakian, Thalia ; Levin Mizrahi, Lissa B. ; Xiao, Gary ; Guy, Stephen ; Malat, Gregory ; Segev, Dorry L. ; Reich, David ; McAdams-DeMarco, Mara</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c455t-a4eeb808bb081221664a36aa337956bc9985167b0b197b960facee8c34749a193</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Cadaver</topic><topic>Cohort Studies</topic><topic>deceased donor kidney transplantation (DDKT)</topic><topic>end-stage kidney disease (ESKD)</topic><topic>Female</topic><topic>frailty</topic><topic>graft failure</topic><topic>Humans</topic><topic>Kidney Transplantation</topic><topic>Male</topic><topic>Middle Aged</topic><topic>mortality</topic><topic>obesity</topic><topic>outcomes</topic><topic>Postoperative Complications - epidemiology</topic><topic>Preoperative Period</topic><topic>protein-wasting malnutrition</topic><topic>Renal transplantation</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>sarcopenia</topic><topic>Tissue Donors</topic><topic>Treatment Outcome</topic><topic>wasting</topic><topic>Weight Loss</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Harhay, Meera Nair</creatorcontrib><creatorcontrib>Ranganna, Karthik</creatorcontrib><creatorcontrib>Boyle, Suzanne M.</creatorcontrib><creatorcontrib>Brown, Antonia M.</creatorcontrib><creatorcontrib>Bajakian, Thalia</creatorcontrib><creatorcontrib>Levin Mizrahi, Lissa B.</creatorcontrib><creatorcontrib>Xiao, Gary</creatorcontrib><creatorcontrib>Guy, Stephen</creatorcontrib><creatorcontrib>Malat, Gregory</creatorcontrib><creatorcontrib>Segev, Dorry L.</creatorcontrib><creatorcontrib>Reich, David</creatorcontrib><creatorcontrib>McAdams-DeMarco, Mara</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>American journal of kidney diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Harhay, Meera Nair</au><au>Ranganna, Karthik</au><au>Boyle, Suzanne M.</au><au>Brown, Antonia M.</au><au>Bajakian, Thalia</au><au>Levin Mizrahi, Lissa B.</au><au>Xiao, Gary</au><au>Guy, Stephen</au><au>Malat, Gregory</au><au>Segev, Dorry L.</au><au>Reich, David</au><au>McAdams-DeMarco, Mara</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association Between Weight Loss Before Deceased Donor Kidney Transplantation and Posttransplantation Outcomes</atitle><jtitle>American journal of kidney diseases</jtitle><addtitle>Am J Kidney Dis</addtitle><date>2019-09-01</date><risdate>2019</risdate><volume>74</volume><issue>3</issue><spage>361</spage><epage>372</epage><pages>361-372</pages><issn>0272-6386</issn><eissn>1523-6838</eissn><abstract><![CDATA[There is debate on whether weight loss, a hallmark of frailty, signals higher risk for adverse outcomes among recipients of deceased donor kidney transplantation (DDKT).
Retrospective cohort study.
Using national Organ Procurement and Transplantation Network data, we included all DDKT recipients in the United States between December 4, 2004, and December 3, 2014, who were adults (aged ≥ 18 years) when listed for DDKT.
Relative pre-DDKT weight change as a continuous predictor and categorized as <5% weight change from listing to DDKT, ≥5% to <10% weight loss, ≥10% weight loss, ≥5% to <10% weight gain, and ≥10% weight gain.
We examined 3 post-DDKT outcomes: (1) transplant hospitalization length of stay (LOS) in days, (2) all-cause graft failure, and (3) mortality.
Unadjusted fractional polynomial methods, multivariable log-gamma models, and multivariable Cox proportional hazards models.
Among 94,465 recipients of DDKT, median pre-DDKT weight change was 0 (interquartile range, −3.5 to +3.9) kg. There were nonlinear unadjusted associations between relative pre-DDKT weight loss and longer transplant hospitalization LOS, higher all-cause graft loss, and higher mortality. Compared with recipients with <5% pre-DDKT weight change (n = 49,366; 52%), recipients who lost ≥10% of their listing weight (n = 10,614; 11%) had 0.66 (95% CI, 0.23-1.09) days longer average transplant hospitalization LOS (P = 0.003), 1.11-fold higher graft loss (adjusted HR [aHR], 1.11; 95% CI, 1.06-1.17; P < 0.001), and 1.18-fold higher mortality (aHR, 1.18; 95% CI, 1.11-1.25; P < 0.001) independent of recipient, donor, and transplant factors. Pre-DDKT dialysis exposure, listing body mass index category, and waiting time modified the association of pre-DDKT weight change with hospital LOS (interaction P < 0.10), but not with all-cause graft loss and mortality.
Unmeasured confounders and inability to identify volitional weight change. Also, the higher significance level set to increase the power of detecting interactions with the fixed sample size may have resulted in increased risk for type 1 error.
DDKT recipients with ≥10% pre-DDKT weight loss are at increased risk for adverse outcomes and may benefit from augmented support post-DDKT.]]></abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>31126666</pmid><doi>10.1053/j.ajkd.2019.03.418</doi><tpages>12</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | American journal of kidney diseases, 2019-09, Vol.74 (3), p.361-372 |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Adolescent Adult Aged Cadaver Cohort Studies deceased donor kidney transplantation (DDKT) end-stage kidney disease (ESKD) Female frailty graft failure Humans Kidney Transplantation Male Middle Aged mortality obesity outcomes Postoperative Complications - epidemiology Preoperative Period protein-wasting malnutrition Renal transplantation Retrospective Studies Risk Factors sarcopenia Tissue Donors Treatment Outcome wasting Weight Loss Young Adult |
| title | Association Between Weight Loss Before Deceased Donor Kidney Transplantation and Posttransplantation Outcomes |
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