{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,26]],"date-time":"2026-04-26T17:35:53Z","timestamp":1777224953918,"version":"3.51.4"},"reference-count":43,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In out\u2010of\u2010sequence (OOS) allocation of deceased donor kidney transplants (DDKTs), providers are allowed to choose recipients irrespective of waitlist priority. Whether candidate obesity affects OOS recipient selection is unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We examined access to OOS\u2010DDKT by candidate body mass index (BMI) using kidney offers from Organ Procurement and Transplantation Network data (1\/2022\u201312\/2023). We compared characteristics of OOS\u2010DDKT versus being last\u2010skipped candidate at the same center using donor\u2010level conditional logistic regression and multilevel modeling among the top\u201020 OOS\u2010performing centers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We identified 4970 OOS\u2010placements and 4588 list\u2010skipped candidates. OOS candidates were older and less likely to be Black. We found a dose\u2013response relationship between weight class and odds of OOS\u2010DDKT. Compared to normal weight candidates, candidates with Class 1, 2, and 3 obesity had 32%, 50%, and 69% lower odds of receiving OOS\u2010DDKT. Mediation analysis suggested candidate BMI partially explained higher access among Asian and Hispanic candidates. There was substantial center\u2010level variation; a 10\u2010unit increase in BMI was associated with &gt;50% lower odds of OOS\u2010DDKT at 3\/20 centers, 20%\u201350% lower odds at 12\/20 centers, and comparable odds at 5\/20 centers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>DDKT candidates with obesity have lower access to OOS kidney allocation. However, equitable distribution irrespective of candidate obesity was observed at a small number of top\u2010performing centers.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ctr.70523","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T15:04:10Z","timestamp":1774969450000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Obesity and Waitlist Access to Out\u2010of\u2010Sequence Deceased Donor Kidney Transplantation"],"prefix":"10.1111","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7751-231X","authenticated-orcid":false,"given":"John R.","family":"Montgomery","sequence":"first","affiliation":[{"name":"Department of Surgery University of Arkansas for Medical Sciences  Little Rock Arkansas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5925-9925","authenticated-orcid":false,"given":"Suhani S.","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Surgery New York University  New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniyar","family":"Akizhanov","sequence":"additional","affiliation":[{"name":"Department of Surgery New York University  New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. 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