SAT-240 OBESITY AS A BARRIER TO TRANSPLANATION IN RENAL REPLACEMENT THERAPY RECIPIENTS

Abstract

Transplantation is the gold standard method of renal replacement therapy (RRT). Due to the scarcity of suitable donors and the anaesthetic risk associated with obesity, patients may be excluded from transplantation due to excessive body weight. The actual data on obesity being a barrier for transplantation in dialysis patients in Toowoomba is unknown. To quantify the perceived problem, an observational study was undertaken. Aims/objectives To quantify how many haemodialysis (HD) and peritoneal dialysis (PD) patients are currently precluded from transplantation activation due to excessive body mass index (BMI). 107 adult HD and PD patients at Toowoomba Hospital had their current weight, height and BMI recorded. Using this information, a weight target was calculated based on a BMI of 32 for non-diabetic patients and a BMI of 30 for diabetic patients as per the local transplantation centre guidelines. No patients were excluded. Thirty-seven patients were diabetic. Twenty-six patients were on PD, 22 satellite HD, 27 home HD and 32 in-centre HD. Reason for transplant preclusion was obtained from medical notes. Length of time on RRT was gathered from the medical notes or ANZDATA database. Cardiac comorbidities followed by excess obesity were the main barriers to transplantation. Twenty-two patients were precluded because of cardiac reasons (21.4%) and 21 patients due to obesity (19.4%). However, a further 13 patients (12.1%) needed to reduce weight before activation once their primary reason for transplant preclusion resolved. This equates to a total of 34 (31.7%) patients who required weight loss prior to transplant activation. Notably, no PD patients required weight reduction for transplantation activation. One PD patient did have an excessive BMI (32.04 kg/m2) however they were deemed too frail for transplantation. Weight was a greater barrier for diabetic patients compared to non-diabetics. Forty-five percent of diabetics had weight as a barrier to transplantation (for 11 patients it was primary barrier and a secondary barrier for six), having to lose an average 25.3kg. Comparably for non-diabetics 22.8% had weight as their primary barrier (for 10 patients it was a primary and six patients a secondary barrier), and required an average loss of 20.9kg. In non-diabetics the primary barrier was cardiac comorbidities. Patients whose primary barrier to transplantation was obesity have spent an average 3.5 years on home or incentre HD (range 6 months to 8 years). It is estimated that the cost of their RRT to date is $A 65,65,2671, equating to an average $A 312,631.80 per patient. The approximate annual cost of transplantation is $A 81,5491 for the first year and $A 11,7701 per annum from year 2 onwards. Eight patients were already activated, and two were being worked up Recommendations