M. N. Mustian1, M. Hanaway1, V. Kumar1, B. A. Shelton1, P. A. MacLennan1, R. D. Reed1, R. Grant1, B. Terry1, J. E. Locke1 1University Of Alabama at Birmingham,Surgery/Transplantation,Birmingham, Alabama, USA
Introduction: Living kidney donors (LKDs) with obesity have increased perioperative risks and elevated risk of end-stage renal disease post-donation. Consequently, obesity serves as a barrier to living kidney donation, and although there is no general consensus in the transplant community regarding selection of obese LKDs, many transplant centers encourage or require weight loss prior to donation for potential LKDs with obesity. Therefore, this study sought to assess patients’ perspectives on weight management strategies prior to donation among obese LKD candidates, and we hypothesized that willingness to participate in a weight loss program may be associated with donor-recipient relationship.
Methods: Obese (BMI ≥ 30 kg/m2) LKD candidates evaluated at a single institution from 9/2017-8/2018 were recruited. A survey was administered, including questions regarding LKD candidates’ baseline exercise and dietary habits, as well as interest in weight management strategies for the purpose of kidney donation approval. Participants were then grouped by relationship to the recipient (first-degree relative or spouse (n=25), compared with all other relationships(n=19)). Descriptive statistics were employed to summarize the survey data, and bivariate analyses were performed.
Results:44 of 45 obese LKD candidates who were approached completed the survey. The majority of participants were female (59.1%), white (63.6%), and the mean participant age was 39.0 years. Nearly 90% of participants expressed willingness to lose weight if necessary to become eligible for donor nephrectomy. 84.1% of participants expressed an understanding of the association between obesity and risk of developing kidney disease, and 97.7% of respondents were interested in weight loss pre-donation to decrease that risk. Additionally, 84.1% of participants communicated an interest in a combined diet and exercise program for pre-donation weight loss. Compared with all other LKD candidates, first-degree relatives and spouses of potential recipients were more likely to be interested in exercise programs (p=0.046) and combined diet and exercise programs (p=0.01) at our institution (Figure). Only 29.6% were interested in bariatric surgery.
Conclusion: Among obese LKD candidates, there was an interest in weight loss for the purposes of living kidney donation approval particularly among first degree relatives and spouses of potential recipients. Future programs designed to promote weight management efforts for obese LKD candidates should be considered.
