Obesity and kidney transplantation

Abstract

Purpose of review Obesity has reached epidemic proportions in the United States. It is a risk factor for developing, among others, heart disease, stroke, type 2 diabetes, and chronic kidney disease (CKD), and thus a major public health concern and driver of healthcare costs. Although the prevalence of obesity in the CKD/end-stage kidney disease population is increasing, many obese patients are excluded from the benefit of kidney transplant based on their BMI alone. For this reason, we sought to review the experience thus far with kidney transplantation in obese patients and associated outcomes. Recent findings Obesity is associated with a lower rate of referral and waitlisting, and lower likelihood of kidney transplantation. Despite increased risk for early surgical complications and delayed graft function, experience from multiple centers demonstrate a clear survival benefit of transplantation over dialysis in most obese patients, and comparable graft and patient survival rates to nonobese recipients. Summary Data suggest that long-term transplant outcomes among obese recipients are similar to those among nonobese. Strategies to achieve pretransplant weight reduction and minimally invasive surgical techniques may further improve results of kidney transplantation in obese recipients.

Timing Considerations for Sleeve Gastrectomy in Kidney Transplant Patients: A Single Center Evaluation

“…Despite increased risk for early surgical complications and delayed graft function in patients with obesity, experience from multiple centers demonstrate a clear survival benefit of transplantation over dialysis, and comparable graft and patient survival rates to nonobese recipients. However, to date, obesity is associated with a lower rate of referral and waitlisting, and lower likelihood of kidney transplantation [ 26 ]. Between January 2009 and December 2018, we conducted a retrospective analysis of our cohort of patients undergoing RKT.…”

Obesity-Related Kidney Disease: Current Understanding and Future Perspectives

“…Ultimately, and regardless of the underlying cause of CKD, the excretory and homeostatic functions of the kidneys may decline to an extent where kidney replacement therapy (dialysis or kidney transplantation) becomes necessary [ 1 ]. However, obesity may limit the chance of being listed as a candidate for kidney transplantation given the surgical challenges, profound scarcity of suitable donors, and negative impact of obesity on the chance of a successful outcome, although a recent report suggested a clear long-term benefit in people with as well as without obesity, between whom the transplantation success and survival did not appear to differ [ 25 , 26 ]. Nevertheless, there is a dire need for efficacious interventions that, when applied in a timely manner, help to prevent or slow the obesity-related accelerated progression of declining kidney function before any invasive replacement strategies become necessary.…”