Guiding Kidney Transplantation Candidates for Effective Weight Loss: A Clinical Cohort Study

Abstract

Background: Obesity is increasingly common in kidney transplant candidates and may limit access to transplantation. Obesity and diabetes are associated with a high risk for post-transplant complications. The best approach to weight loss to facilitate active transplant listing is unknown, but bariatric surgery is rarely considered due to the patient and physician-related apprehension, among other factors. Methods: We aimed to determine the magnitude of weight loss, listing, and transplant rates in 28 candidates with a mean BMI of 44.4 (±4.6) kg/m2 and diabetes treated conservatively for 1-year post-weight loss consultations (Group 1). Additionally, we evaluated 15 patients (Group 2) who met inclusion criteria but received bariatric intervention within the same time frame. All patients completed a multidisciplinary weight management consultation with at least 1 year of follow-up. Results: In the conservatively managed group (Group 1), the mean weight at the time of initial consultation was 126.5 (±18.5) kg, and BMI was 44.4 (±4.6) kg/m2. At 1-year post weight loss consultation, the mean weight decreased by 4.4 ({plus/minus}8.2) kg to 122.9 (±17) kg, and the mean BMI was 43.0 (±4.8) kg/m2, with a total mean body weight decrease of 3%; p=0.01. Eighteen patients (64.2%) did not progress to become candidates for active listing/transplantation during the follow-up time of 4.0 ({plus/minus}2.9) years, with 15 (53.6%) subsequently developing renal failure/diabetes-related comorbidities prohibitive for transplantation. In contrast, mean total body weight decreased by 19% at 6 months post-bariatric surgery, with a mean BMI of 34.2 ({plus/minus}4) and 32.5 ({plus/minus}3.7) kg/m2 at 6 and 12 months, respectively. Bariatric surgery was strongly associated with subsequent kidney transplantation (HR 8.39; [1.71, 41.19]; p=0.0087). Conclusion: A conservative weight loss approach involving multidisciplinary consultation was ineffective in most kidney transplant candidates with diabetes, suggesting a more proactive approach is needed.