Mupfudze TG, Handarova DG, Noreen SMG, Schold JD, Paramesh A, Mohandas R. Impact of obesity and income on the likelihood of kidney transplantation: A retrospective cohort study. World J Transplant 2026; 16(3): 120639 [DOI: 10.5500/wjt.120639]
Corresponding Author of This Article
Tatenda G Mupfudze, PhD, Senior Researcher, United Network for Organ Sharing, 700 N. 4th Street, Richmond, VA 23219, United States. tatenda.mupfudze@unos.org
Research Domain of This Article
Urology & Nephrology
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research-article
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Mupfudze TG, Handarova DG, Noreen SMG, Schold JD, Paramesh A, Mohandas R. Impact of obesity and income on the likelihood of kidney transplantation: A retrospective cohort study. World J Transplant 2026; 16(3): 120639 [DOI: 10.5500/wjt.120639]
World J Transplant. Sep 18, 2026; 16(3): 120639 Published online Sep 18, 2026. doi: 10.5500/wjt.120639
Impact of obesity and income on the likelihood of kidney transplantation: A retrospective cohort study
Tatenda G Mupfudze, Dzhuliyana G Handarova, Samantha M G Noreen, Jesse D Schold, Anil Paramesh, Rajesh Mohandas
Tatenda G Mupfudze, Dzhuliyana G Handarova, Samantha M G Noreen, United Network for Organ Sharing, Richmond, VA 23219, United States
Jesse D Schold, Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
Anil Paramesh, Department of Surgery, Tulane Transplant Institute, Tulane University School of Medicine, New Orleans, LA 70112, United States
Rajesh Mohandas, Section of Nephrology & Hypertension, Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA 70112, United States
Author contributions: Mupfudze TG and Mohandas R conceived the research question; Mupfudze TG, Noreen SMG, Schold JD, Paramesh A, and Mohandas R contributed to the study design; Handarova DG and Noreen SMG performed data analyses; Mupfudze TG drafted the manuscript and all authors revised the manuscript; and all coauthors contributed to data interpretation.
AI contribution statement: AI tools (specifically Copilot) were used solely for linguistic refinement and formatting assistance. No AI tool was involved in the generation of research data, interpretation of results, or formulation of conclusions. All AI-generated outputs were critically reviewed and revised by the authors.
Institutional review board statement: This study was approved by the Advarra Institutional Review Board with a waiver of informed consent, and all procedures were performed in accordance with the Declaration of Helsinki.
Informed consent statement: This study was approved by the Advarra Institutional Review Board with a waiver of informed consent.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: Data sharing is not applicable to this article as no new data were created or analyzed in this study.
Corresponding author: Tatenda G Mupfudze, PhD, Senior Researcher, United Network for Organ Sharing, 700 N. 4th Street, Richmond, VA 23219, United States. tatenda.mupfudze@unos.org
Received: March 4, 2026 Revised: May 18, 2026 Accepted: June 23, 2026 Published online: September 18, 2026 Processing time: 179 Days and 17.4 Hours
Abstract
BACKGROUND
This study evaluated the joint and modifying effects of obesity and income on access to kidney transplantation, stratified by race/ethnicity.
AIM
To investigate whether income modifies the association between body mass index (BMI) and the likelihood of deceased donor kidney transplantation (DDKT) and living donor kidney transplantation (LDKT).
METHODS
We conducted a retrospective cohort study of 54891 adult kidney-only candidates added to the United States waiting list in 2020 and 2022, using data from the Organ Procurement and Transplantation Network and LexisNexis.
RESULTS
Overall, 47% of candidates were obese (BMI ≥ 30 kg/m²). In multivariable models, BMI 30- < 35 was associated with a lower likelihood of DDKT for non-Hispanic White and non-Hispanic Black candidates [sub-distribution hazard ratio (sHR): 0.93 for both]. BMI ≥ 35 was associated with an 18% lower likelihood to DDKT for non-Hispanic White candidates only. Low income was associated with higher likelihood of DDKT among non-Hispanic White (sHR: 1.34) and Hispanic/Latino (sHR: 1.20) candidates but was not associated with DDKT among non-Hispanic Black candidates. In interaction models, income-related differences in DDKT were most consistently observed among nonobese nonHispanic White and Hispanic/Latino candidates. For LDKT, both BMI ≥ 35 and low income were associated with lower likelihood of transplantation across all racial and ethnic groups; low income was also associated with reduced likelihood of LDKT among non-obese candidates in interaction models.
CONCLUSION
Obesity and income are differentially associated with access to transplantation by racial/ethnicity and transplant modality, highlighting the importance of jointly considering clinical and social risk factors in transplantation.
Core Tip: This study examines how obesity, measured by body mass index (BMI), and individual income jointly influence access to deceased donor kidney transplantation and living donor kidney transplantation among adults listed in the United States. By stratifying analyses by race and ethnicity, we identify distinct patterns in how BMI and income affect transplant likelihood. These findings highlight the need to consider both clinical and social risk factors when designing strategies to improve equity in kidney transplant access.
