Policy: Kidney/Pancreas Pre-Transplant: Body Mass Index (BMI) Guidelines for Transplant Recipients
being Evaluated and Listed
Statement: Status: Active
Activation Date: 04/01/2010
Hospital/Institution: Emory University Hospitals
Affected Departments: Emory Hospital’s Kidney (Pancreas) Transplant Program
Vision Strategy: Patient Care
Policy Statement:
The Emory Kidney (Pancreas) Transplant Program multidisciplinary team will evaluate the recipient’s candidacy for
transplantation based on a calculated Body Mass Index (BMI). Obesity is defined by a BMI of 30 or greater. Severe
obesity is defined by a BMI of 35 or greater. Morbid obesity is defined by a BMI of 40 or greater. An estimated 97
million adults in the United States are overweight or obese, a condition that substantially raises their risk of
morbidity from hypertension, dyslipidemia, type 2 diabetes, coronary heart disease, stroke, gallbladder disease,
osteoarthritis, sleep apnea and respiratory problems, and endometrial, breast, prostate, and colon cancers. Higher
body weights are also associated with increases in all-cause mortality [1]. The recipient’s BMI is a potential
contributive factor to the recipient’s success rate post-transplant.
Scope/Procedure:
For the purpose of standardization in the calculation of the BMI, the measurement is weight in kilograms divided by
height in meters squared.
Guidelines for Calculation of BMI for Referred Transplant Candidates
All recipient referrals will be processed regardless of BMI
A. All recipients will be scheduled for EMMI education
B. All recipients who meet EMMI scheduling guidelines will
be scheduled for Day 1 Evaluation.
Evaluation:
A. Every recipient candidate will be seen and evaluated by team per Day 1
protocol.
B. Recipients with a BMI of 38 or less will undergo the full Day 1
assessment, interim testing and Day 2 consults per protocol.
C. Recipients with a BMI between 38 and 40 will undergo the full Day 1
assessment, interim testing and Day 2 consults per protocol. These
recipients will be evaluated by the team dietitian and if interested, referred
to the Bariatric Study Nurse for consideration for the Bariatric Weight Reduction Program.
D. Recipients with a documented BMI 40 and above will undergo the full Day 1 assessment, (EKG, lab work,
chest x-ray, H&P). Interim testing and Day 2 consults will not be scheduled until they reach a BMI of 40 or
actively engaged in a Bariatric Weight Reduction program. Actively engaged is defined as completion of
Bariatric program education and verified insurance coverage for planned procedure.
1- The recipient candidate will be counseled concerning weight
requirements and provided with weight loss goals and expectations
by the clinical dietitian. If recipient’s BMI is between 38 and 55, Emory’s Bariatric
research RN will contact patient on Day 1 of evaluation to counsel regarding
Bariatric program.
2- Candidates will be reviewed by the team at selection
conference. A status determination will be made. Unless there are
special mitigating circumstances a “not a candidate”letter will be
generated and the referral and evaluation will be closed. Recipient, Referring MD
and dialysis unit will be notified per communication policy.
3- Weight loss goals and expectations will be communicated to the
patient, Referring MD and dialysis unit dietitian in the evaluation
conference summary notification document.
4- Patient will contact the Emory Transplant Center Renal and Pancreas program when
goal has been attained or the Emory Transplant Center Renal and Pancreas program will
be contacted by Bariatric program with indication that patient is actively engaged in a
weight reduction program. Then patient will complete Day 2 of the evaluation and be
reviewed by Transplant selection committee for determination of transplant candidacy.
Bariatric program will be notified by Coordinator of patient’s candidacy status for
transplant.
Guidelines for Approval for Listing and Waitlisted Transplant Candidates
At Evaluation, all recipients will receive a Nutrition Consultation. To be approved for UNOS listing, recipient
candidates must achieve the evaluation goal:
BMI of less than or equal to 38 (Kidney or Kidney/Pancreas - inactive)
BMI of less than or equal to 35 (Kidney - active)
BMI of less than or equal to 30 (Kidney/Pancreas - active)
BMI of >38 and scheduled for bariatric surgery (Kidney or KP – inactive)
Once approved and listed (status 7) for transplant, regardless of weight
loss method used, the multidisciplinary team will expect the candidate to
notify the transplant center as soon as weight goal is reached. The
transplant center will:
A.
Obtain and record identified listed inactive candidate’s weight
annually.
B. Candidates who fail to meet weight loss requirements for active
listing for three consecutive years will be notified and delisted
for failure to meet weight loss requirements. Notification letter
will be sent per UNOS guidelines with copy to referring MD and dialysis unit.
Renal Transplant Leadership Group
Approval Dates: 3/24/2010
Revisions: 6/30/2011, 12/7/2011, 5/9/2012