title: Challenges of abdominal organ transplant in obesity.
abstract: Obesity is a worldwide epidemic and public health crisis associated with severe comorbidity leading to end organ dysfunction and poorer transplant outcome. Large population studies show decreased patient and graft survival in obese kidney transplant patients. Despite the poorer outcomes, kidney transplant is considered because of the survival benefit as compared to the wait-listed dialysis patients. In liver transplantation, the benefit of transplant as compared to remaining on the list is obvious because there is no viable liver dialysis at this time.Obesity in potential organ donors impacts both medical and surgical issues. Obesity-related kidney disease affects both the remaining and transplanted kidney. Pancreas donor organs are associated with decreased early graft survival. Liver donor organs with significant steatosis lead to an increased risk for delayed function or nonfunction of the organ.Immunosuppressive drugs with variable lipophilicity and altered volume of distribution can greatly affect the therapeutic usefulness of these drugs.Transplant candidates benefit from a multidisciplinary team approach to their care. As the epidemic progresses and less invasive treatments for metabolic surgery evolve, we are likely to see more patients lose weight before transplant as we continue to strive for improved outcomes.
authors: Division of Abdominal OrganTransplant, Tulane University Medical Center, New Orleans, LA, USA. mkillack@tulane.edu
authors: Mary
authors: M
authors: Killackey
authors: Rubin
authors: R
authors: Zhang
authors: Kelly
authors: K
authors: Sparks
authors: Anil
authors: A
authors: Paramesh
authors: Douglas
authors: D
authors: Slakey
authors: Sander
authors: S
authors: Florman
mesh_terms: D050110:Bariatric Surgery; D015992:Body Mass Index; D015897:Comorbidity; D003430:Cross-Sectional Studies; D051799:Delayed Graft Function / Q000453:epidemiology / Q000209:etiology; D006084:Graft Rejection / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D016030:Kidney Transplantation; D009765:Obesity / Q000150:complications* / Q000453:epidemiology; D016377:Organ Transplantation; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011300:Preoperative Care; D012307:Risk Factors; D014019:Tissue Donors; D014481:United States; D015431:Weight Loss
chemical_list: D007166:Immunosuppressive Agents