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Title: The application of body mass index-based eligibility criteria may represent an unjustified barrier to renal transplantation in people with obesity.
Austin Authors: Tan, Alanna ;Wilson, Scott;Sumithran, Priya 
Affiliation: Endocrinology
Department of Nephrology, Alfred Health, Melbourne, Victoria, Australia
Central Clinical School, Monash University, Melbourne, Victoria, Australia
Department of Medicine (St Vincent's), University of Melbourne, Melbourne, Victoria, Australia
Issue Date: Apr-2022
Date: 2021-12-28
Publication information: Clinical Obesity 2022; 12(2): e12505
Abstract: The prevalence of both obesity and end-stage kidney disease is increasing. In many centres, obesity is considered a relative contraindication to kidney transplantation due to an association with short- and longer-term adverse outcomes. This leads to delayed transplant waitlisting and longer organ waiting times for people with obesity. This review evaluates whether intentional pre-transplant weight loss in people with obesity improves kidney transplant outcomes. There are currently no data showing that non-surgical weight loss of 10% or more improves graft or patient survival over 4-5 years. Outcomes from bariatric surgery cohorts have been generally neutral or favourable after pre-transplant weight loss of ~25%. Given the survival benefit of kidney transplantation compared to maintenance dialysis, and the difficulty of achieving and maintaining weight loss, the common practice of recommending weight loss to achieve arbitrary targets prior to waiting list activation needs to be carefully considered.
DOI: 10.1111/cob.12505
ORCID: 0000-0002-9576-1050
Journal: Clinical Obesity
PubMed URL: 34964256
PubMed URL:
Type: Journal Article
Subjects: bariatric surgery
kidney transplantation
weight loss
Appears in Collections:Journal articles

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