[Clearing the Path: Enhancing Kidney Transplant Access Through Panniculectomy]

Obesity poses an increasing challenge in transplant medicine for patients with end-stage renal disease (ESRD). Despite weight reduction, many of these patients are excluded from kidney transplantation due to a pronounced abdominal panniculus, as this region is prone to wound healing complications and impedes surgical access. The aim of this study was to further evaluate the safety and clinical relevance of abdominal panniculectomy - previously investigated in a pilot study - as a means to improve transplant eligibility in obese ESRD patients.

A retrospective analysis was conducted on 16 ESRD patients who underwent panniculectomy between 2016 and 2025 in preparation for a planned kidney transplantation. Collected data included demographic characteristics, perioperative parameters, postoperative complications, and transplant outcomes.

At the initial presentation to the transplant centre, the mean body mass index (BMI) was 41.1 kg/m² (range 28.5-58.1 kg/m²) and was reduced to 32.1 kg/m² (range 28.1-36.7 kg/m²) prior to panniculectomy. No major complications occurred; only two patients experienced minor wound healing issues that did not require surgical revision. All patients except one were listed as active transplant candidates six weeks after panniculectomy. No postoperative wound complications occurred in the transplanted patients.

Abdominal panniculectomy is a safe and effective procedure for optimising the surgical conditions in obese ESRD patients. In an interdisciplinary, two-stage approach, it can successfully prepare patients previously ineligible for kidney transplantation. The study highlights the importance of individualised surgical strategies in highly selective high-risk populations.