Emerging Topics In Obesity Treatment in the Setting of Organ Transplantation

This review summarizes current evidence on the treatment of obesity in the solid organ transplant setting and identifies evidence gaps.

Lifestyle modification, pharmacotherapy, and metabolic and bariatric surgery are all potential options for management of obesity in the setting of solid organ transplantation. Limited available data on use of incretin-based pharmacotherapy in solid organ transplantation support its safety and effectiveness in appropriately-selected patients, however prospective large-scale studies are needed. Obesity treatment is an important component of transplant care, as obesity is associated with increased mortality and adverse graft outcomes. Lifestyle modification, anti-obesity pharmacotherapy, and metabolic and bariatric surgery can be employed safely in both pre- and post-transplant settings. Newer incretin-based pharmacotherapy, including glucagon-like peptide 1 (GLP-1) receptor agonists and dual GLP-1 receptor agonist/gastric inhibitory polypeptide offer potential for substantial weight loss and improved cardiometabolic outcomes. Bariatric and endoscopic metabolic procedures can be beneficial in carefully selected patients pre- or post-transplant. Precision approaches including sarcopenic obesity and measurement of body composition can help tailor interventions. These developments highlight the importance of multidisciplinary management and underscore the need for additional research within transplant populations.