Obesity and Kidney Transplant: Addressing Challenges and Enhancing Outcomes

According to the Centers for Disease Control and Prevention (CDC), more than 40% of adults in the United States are considered obese, defined as a body mass index (BMI) of 30 kg/m² or higher. This medical condition, characterized by excess body fat, significantly impacts health and poses challenges in kidney transplant, both for recipients and donors.

The rising prevalence of obesity among patients requiring kidney transplants necessitates careful evaluation by transplant centers. At UPMC Harrisburg, candidates with a BMI of 40 kg/m² or higher are educated about the complications of obesity and its impact on transplant outcomes, including short-term risks like vascular complications, delayed wound healing, infections, as well as long-term risks such as reduced or delayed graft function and decreased graft survival. To mitigate these risks, UPMC Harrisburg implements a multidisciplinary approach that includes patient education on the implications of obesity, lifestyle modifications guided by UPMC Bariatric Services, and follow-up monitoring over six to eight months to achieve the target weight for transplant eligibility.

For living-kidney donors, BMI criteria is different due to the unique challenges of preserving donor health after nephrectomy. At UPMC Harrisburg, the BMI cutoff for donors is 35 kg/m². If a potential donor is obese, they are encouraged to lose weight prior to transplant to ensure that their remaining kidney remains healthy and functional.

“Since donors are typically healthy individuals and a transplant will take one healthy kidney out of their system, we need to leave them with one healthy kidney,” says Faizan Syed, MD, transplant nephrologist at UPMC Harrisburg, who is certified in obesity medicine. “Donors usually are not morbidly obese, but are typically slightly above our BMI cutoff. Obese donors are encouraged to lose weight so they can be able to donate a kidney to a loved one or even a stranger. For someone who is invested in the donation process, they are willing to make strides to lose weight and most of the time, they come back to us within six to eight months and have lost weight. From there, they can become a candidate to become a living donor.”

While diet and exercise are essential, many patients benefit from weight-loss medications.

“Obesity is a social taboo,” says Dr. Syed. “We are taught that only exercise and diet can help combat obesity. Now, studies have shown that patients may also need medication as well to lose weight prior to transplant. We don’t want our patients to get discouraged if they’re not losing weight with exercise and diet alone; they may need medication to go along with it. But, it’s important to note that medication alone is not the answer and every patient is different.”

UPMC’s robust network of transplant experts across Pennsylvania—including Harrisburg, Pittsburgh, and Erie, Pa.—provides life-saving, accessible care to patients. By addressing obesity and its challenges, UPMC remains committed to improving outcomes for kidney transplant recipients and donors alike.

“The most important thing that our patients, especially transplant recipients, need to understand is that the reason we tell them to lose weight is because of their own benefit and for the benefit of the new organ that they’re going to receive,” says Dr. Syed. “We want our patients to have their new kidney for a long time. At the end of the day, transplant is a treatment, it’s not a cure, so we want to make sure that we’re providing them with the right treatment and having them lose weight is part of that treatment.”

To refer a patient or request a consultation at UPMC Harrisburg in Harrisburg, Pa., call 717-231-8700 or email transplanthbg@upmc.edu. To refer a patient or request a consultation at UPMC Presbyterian in Pittsburgh, Pa., call 412-692-4081 or email UPMCKidneyReferrals@upmc.edu. To refer a patient or request a consultation at UPMC Hamot in Erie, Pa., call 814-877-3625 or email hamottransplant@upmc.edu.