title: Management of the obese kidney transplant candidate.
abstract: Obesity is an increasingly common condition that can exclude end stage renal disease patients from consideration of kidney transplantation. The optimal management of obese transplant candidates is uncertain, especially the use of pharmacologic therapies or bariatric surgery. We review the rationale to consider transplantation in obese patients, the impact of obesity on access to kidney transplantation, the evidence for obese patients to lose weight loss prior to kidney transplantation, peri-operative management considerations and specific weight loss strategies prior to transplantation. We also propose an algorithm for pre-transplant management of obese transplant candidates that takes into consideration the patient's peri-operative risk, the anticipated time to transplantation and the risk of delayed graft function. Finally, we suggest a number of areas in need of further research as well as health policy considerations to improve the care of obese kidney transplant candidates.
authors.affiliation: Division of Nephrology, University of British Columbia.
authors.forename: Julie
authors.initials: J
authors.lastname: Lesage
authors.affiliation: Division of Nephrology, University of British Columbia; Centre for Health Evaluation and Outcomes Sciences, University of British Columbia. Electronic address: jgill@providencehealth.bc.ca.
authors.forename: John S
authors.initials: JS
authors.lastname: Gill
mesh_terms: D015992:Body Mass Index; D015897:Comorbidity; D051799:Delayed Graft Function / Q000401:mortality* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology*; D019990:Perioperative Care / Q000379:methods; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome