Anti-obesity Pharmacotherapy for Transplant Recipients

To review anti-obesity pharmacotherapy options and data to guide use in liver and kidney transplant recipients.

The number of liver and kidney transplant recipients with obesity (BMI ≥ 30 kg/m²) and concurrent disorders continues to grow. Up to 40% of liver and 33% of kidney recipients have obesity at transplant. Post-transplant weight gain is multi-factorial and common. Additionally, obesity and weight gain lead to lower allograft survival, increased cardiovascular risk, and decreased patient survival. Despite the high-risk population, anti-obesity medication use has not been widely studied or used in transplant recipients. Nutrient-stimulated hormones (NuSH) medications (glucagon-like peptide-1 receptor [GLP-1] agonists and dual agonists (GLP-1 and glucose-dependent insulinotropic polypeptide [GIP] receptor agonists) are highly effective agents for obesity treatment and cardiovascular event risk reduction in the general population and have spurred interest in obesity management in the transplant community. Data from randomized, placebo-controlled trials and integration of obesity medication expertise into routine care for transplant recipients is key to ensure improvement in long-term graft and patient survival.