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The effect of donor obesity on kidney transplantation success has long been an overlooked clinical research area. Even though there is no strict guideline in most countries prohibiting donation from obese individuals, most candidates with BMI over 35-40 kg/m2 are overturned due to concerns regarding the renal functional deterioration in the donor over the long run. The effects of excessive fat mass on renal function and allograft survival have been analyzed by several longitudinal and follow-up studies. These studies have documented the deleterious effect of long term graft outcomes by excessive body mass in living kidney donors and de novo obesity or pre-existing obesity worsening post transplantation on kidney outcomes. However, there is a paucity of clinical trials aimed at countering overweight and obesity in living or deceased kidney donors and in transplant patients. In this review, we will briefly review mechanism whereby fat excess may induce adverse kidney outcomes to then describe the effect on graft function and survival by living obese donors along with the effect post transplantation obesity on the same outcomes.

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