Obesity in Renal Transplantation

Abstract

<b><i>Background:</i></b> Data from the WHO show an increasing rate of overweight and obesity in general population in the last decades. This increase in obesity also affects population with end-stage renal disease (ESRD) and kidney transplant (KT) candidates. <b><i>Summary:</i></b> In this review, we focused on how obesity impacts on KT stages: access to KT and outcomes of KT candidates; how to reduce weight and its consequences; short and long-term outcomes in obese recipients and the impact of weight variations; and the implications of obesity in living donor KT. We searched MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials until November 30, 2020. We selected systematic reviews and meta-analyses and randomized clinical trials. When no such reports were found for a topic, observational studies were included in the assessment. <b><i>Key Messages:</i></b> Although obesity is a risk factor to present worst outcomes after KT, several studies have demonstrated a survival benefit compared to patients who continue on dialysis. There is a need for a public health campaign to raise awareness in KT candidates and to highlight the importance of self-care, increasing exercise, healthy diet, and weight loss.

Body mass index affects kidney transplant outcomes: A cohort study over 5 years using a steroid sparing protocol

“…It is very easy to dismiss access for transplantation based on BMI, as an easily measured metric. However, this study shows that with a steroid sparing protocol at five years, overall survival probability is the same, independent of BMI, and thus the expected life after transplantation ( 20 ) is not a reason to not list patients based on BMI alone.…”