Obesity in kidney transplantation: Clinical and economic implications .

摘要

Kidney transplantation provides evident improvement to the health of patients with end-stage renal disease. Given a shortage of viable kidney donations, those involved in transplantation are under scrutiny to optimize utility while curtailing costs incurred to both the patient and the health care system. The degree to which a patient improves has been shown to differ by various clinical and demographic characteristics. Parallel to the general trend in the United States, obesity is on the rise among kidney transplant recipients. Perhaps the increased risks to inferior health outcomes and increased costs of treatment experienced by obese kidney transplant recipients indicate that the disbursement of limited organs is not optimized. Furthermore, the severity of substandard health outcomes and greater health care costs may suggest that transplantation is no longer the best option for certain obese dialysis patients.;This dissertation presents an examination of obesity, analyzed via body mass index (BMI), in kidney transplantation in three studies. The first study investigates the short-term impact of privately-insured kidney transplant recipient obesity on health outcomes and associated costs. The results of this study indicate that costs of care for obese recipients were statistically higher compared to normal BMI recipients. Rates of delayed graft function were higher for non-normal BMI recipients. The second study examines the short-term impact of publically-insured kidney transplant recipient obesity on health care outcomes and costs. The results designate that both underweight and extremely morbidly obese recipients had increased costs of care than normal BMI recipients. Rates of delayed graft function, graft failure, and patient survival were substandard for non-normal BMI groups. The third study uses summary results similar to those in the second study, as well as previous research, to investigate the cost-effectiveness of kidney transplantation compared to dialysis for each level of BMI. The results of this study establish that all levels of BMI are cost-effective over dialysis, despite varying levels of effect.;The results of these studies provide evidence to further improve the efficiency of kidney transplantation. This dissertation emphasizes the need for additional attention towards the obese kidney transplant candidate in an effect to reduce negative health outcomes and curtail medical spending.