Management of the obese kidney transplant candidate

Area of Science:

• Nephrology
• Transplantation Surgery
• Bariatric Medicine

Background:

• Obesity is a growing concern, often excluding end-stage renal disease (ESRD) patients from kidney transplantation.
• Optimal management strategies for obese transplant candidates, including pharmacologic therapies and bariatric surgery, remain uncertain.

Purpose of the Study:

• To review the rationale for considering kidney transplantation in obese patients.
• To examine obesity's impact on access to kidney transplantation and evaluate pre-transplant weight loss evidence.
• To propose an algorithm for managing obese kidney transplant candidates.

Main Methods:

• Comprehensive literature review on obesity, ESRD, and kidney transplantation.
• Analysis of evidence supporting pre-transplant weight loss interventions.
• Development of a management algorithm considering peri-operative risk, transplant time, and graft function.

Main Results:

• Obesity significantly impacts eligibility and outcomes for kidney transplant recipients.
• Evidence supports pre-transplant weight loss to improve outcomes, though optimal methods vary.
• A proposed algorithm aids in stratifying and managing obese candidates.

Conclusions:

• Kidney transplantation is a viable option for carefully selected obese ESRD patients.
• Personalized pre-transplant weight management strategies are essential for optimizing outcomes.
• Further research and policy changes are needed to improve care for this population.