Kidney transplantation in obese patients

Dr Christine Ribic is an associate professor in the Division of Nephrology at McMaster University.

Is kidney transplantation contraindicated in obese patients?

Christine Ribic, MD, MSc: The short answer to that is, “It is complicated and it is not contraindicated,” but there are several factors to consider. We know that in general patients that have a body mass index (BMI) greater than 35, and even in some cases actually BMIs just slightly above 30, are at an increased risk of complications post transplantation. These complications include wound dehiscence, infection of the wound itself, and even perhaps increased risks of rejection.

Oftentimes programs will internally set a BMI at which they will start thinking about increased risks for those recipients and typically will look at BMIs of 35. However, even in patients who have lower BMIs or have a BMI of 35 we also need to look at body morphology. Patients that have a lot of central adiposity may be at a particularly increased risk of complications compared with those that may carry weight in different areas on their body.

So it is not a contraindication. If we do have concerns, many recipients may undergo a weight loss or even medical bariatric programs—or even in some cases surgical bariatric programs and surgery—to lose weight and then become eligible for kidney transplantation.