Kidney Transplant Eligibility Expanded for Obese Patients with Renal Dysfunction

People with obesity and end-stage renal disease (ESRD) now have new hope thanks to a collaborative study conducted by a bariatric and transplant surgery team. The authors of the study examined the effects of bariatric and metabolic surgery on patients with end-stage renal disease (ESRD) and whether such surgery could improve the patients’ eligibility for kidney transplantation. The American College of Surgeons Journal has published the findings.

“Obesity is a worsening problem in the United States, significantly impacting transplant eligibility. We established the CORT initiative – a collaborative for obesity research in transplantation – recognizing the urgent need to address this issue, especially in underserved populations who suffer the most from obesity-related diseases,” said corresponding study author Anil Paramesh, MD, MBA, FACS, professor of surgery, urology, and paediatrics and director of the kidney and pancreas transplant programs at Tulane University School of Medicine.

Without a transplant, ESRD patients face numerous challenges; their only option is to prolong life with dialysis, which is not only expensive and time-consuming but also significantly lowers quality of life, according to Dr. Paramesh. The 183 ESRD patients who were referred for bariatric surgery were followed from January 2019 to June 2023. Of these, 36 underwent weight loss surgery, and 10 later underwent kidney transplants. The average BMI was reduced by 27% at the time of transplant, according to the results, and hypertension and diabetes control were also improved. The general health and transplant viability of the patients were improved by this advancement in the management of comorbid conditions.

With obesity being a major cause of transplant exclusion, this collaborative program represents a path forward for patients who previously would be ineligible, Dr Paramesh said and may help pave the way for increased patient education and access.
“We’ve seen that bariatric surgery is not just about weight loss; it significantly improves other serious conditions like diabetes, high blood pressure, and sleep apnea. This approach not only helps in reducing the patients’ weight to a level where they can safely receive a transplant but also addresses the broader issue of health care disparities, particularly affecting Black and lower-income individuals,” said Dr Paramesh.
However, the study also faced challenges, including a high drop-off rate of patients unwilling or unable to undergo surgery, and unique postoperative complications such as hypotension.