University of Wisconsin-Madison, Madison, WI, USA.
George Washington School of Medicine and Health Sciences, Washington, DC, USA.
Pediatr Nephrol. 2024 Nov;39(11):3333-3338. doi: 10.1007/s00467-024-06453-y. Epub 2024 Jul 15.
Obesity is associated with increased complications, rejection, and graft loss after kidney transplantation in adult and pediatric recipients. Elevated body mass index (BMI) is a common contraindication to transplant at adult kidney transplant programs; however, there is no data on such limitations for pediatric patients.
Between October and December 2022, we conducted a survey of Pediatric Nephrology Research Consortium centers assessing the use of BMI in pediatric kidney transplant evaluation. Centers reporting utilization of BMI cutoffs were invited to submit patient-level data on children declined for active transplant listing due to BMI.
Thirty-nine centers responded to the survey (42% response rate); 51% include BMI in their written listing criteria, with a median BMI "cutoff" of 39 kg/m (range 30-50 kg/m). Between January 1, 2016, and December 31, 2021, 30 children at 15 transplant centers were declined for listing status due to BMI. Patient-level data was provided for 19 children (63%) who were denied active listing status; median BMI was 42 kg/m (range 35.8-49.4 kg/m) and 84% were on dialysis. One year after evaluation, seven patients (37%) had proceeded to active wait list status. Eight (42%) remained in inactive status and four (21%) were unlisted; ten of these 12 patients (83%) were on dialysis.
The use of BMI in pediatric kidney transplant evaluation and listing varies among centers, but BMI limits access to transplant for some children. More information is needed on the outcomes of obese pediatric kidney candidates who are and are not transplanted, to guide development of national and international consensus.
肥胖与成人和儿科受者肾移植后的并发症、排斥反应和移植物丢失增加有关。升高的体重指数（BMI）是成人肾脏移植项目中常见的移植禁忌证；然而，对于儿科患者，尚无此类限制的数据。
在 2022 年 10 月至 12 月期间，我们对儿科肾脏病研究联盟中心进行了一项调查，评估 BMI 在儿科肾移植评估中的使用情况。报告使用 BMI 截止值的中心被邀请提交因 BMI 而被拒绝列入活跃移植名单的患儿的患者水平数据。
39 个中心对调查做出了回应（42%的回应率）；51%的中心将 BMI 纳入其书面列入标准，中位数 BMI“截止值”为 39kg/m（范围 30-50kg/m）。2016 年 1 月 1 日至 2021 年 12 月 31 日，15 个移植中心的 30 名儿童因 BMI 被拒绝列入名单。15 个移植中心中有 19 名儿童（63%）提供了患者水平数据，这些儿童被拒绝列入活跃名单；中位数 BMI 为 42kg/m（范围 35.8-49.4kg/m），84%的儿童正在接受透析。评估一年后，7 名患者（37%）进入了活跃等待名单。8 名（42%）仍处于不活跃状态，4 名（21%）未列入名单；这 12 名患者中的 10 名（83%）正在接受透析。
BMI 在儿科肾移植评估和列入名单中的使用在中心之间存在差异，但 BMI 限制了一些儿童获得移植的机会。需要更多关于肥胖儿科肾脏候选者是否接受移植及其结果的信息，以指导制定国家和国际共识。
