The Conundrum of High Body Mass Index in Kidney Transplant Patients

Abstract

Obesity is on the rise and the number of end stage renal disease patients who are obese parallel this trend. There is no universally accepted guideline for wait-listing end stage renal disease obese patients in order to reduce surgical complications and improve survival of the kidney graft. Criteria for acceptance are variable among transplant centres, as do posttransplant policies. Careful risk assessment to maximise the benefits of the limited organ donor resource must be undertaken prior to waitlist an obese kidney transplant candidate. Likewise, close post transplantation follow-up for this higher risk group should be implemented as per the general population, but the body mass index per se should not be a barrier to get access to transplantation.

Obesity affects graft function but not graft loss in kidney transplant recipients

“…9 The post-transplant scenario is therefore a highly recommended time period during which to encourage weight loss and discuss the pros and cons of different strategies to achieve this. 10 If avoiding steroids is beneficial in the first year after transplant, the outcomes in the mid and long term will be influenced by the other concomitant conditions that obesity induces, namely metabolic syndrome and diabetes, hypertension, and increased risks of cardiovascular and chronic kidney disease. 11 What strategies can be implemented to preserve graft function?…”

Obesity and bariatric intervention in patients with chronic renal disease

“…The increasing concern regarding the rising incidence and prevalence of chronic kidney disease (CKD) and obesity worldwide has recently increased the efforts to highlight a possible strategy with which to improve the outcomes of this patient population. 4…”