SCM13: The Obese patient: When is big too big?

As a transplant nephrologist myself, one session I particularly enjoyed in the NKF was “Controversies in Kidney Transplantation.” Three experienced speakers showcased their knowledge on difficult topics and captivated both the general nephrology and transplant audience. Here is a brief recap of one of the 3 talks.

The Obese patient: When is big too big?

Basically it depends on center preference. Sounds like the easy way out but as Dr. Krista Lentine explained in her talk, it’s quite complex. Published guidelines (Am J Transplant 2001) suggest targeting a BMI under 30, as do more recent Canadian guidelines, but acknowledge that there is no data to suggest at what BMI to exclude a patient. She explains however, that obese patients have higher complications post transplantation including delayed graft function and wound complications. In addition, they tend to cost the healthcare system more than patients that are not obese. As to the thought that obese patients fair better on dialysis, it seems that a closer look at the data suggests that it is muscle mass – not fat – which is protective. Finally, although some centers recommend weight loss Dr. Lentine acknowledged that there is no data to suggest losing weight improves post transplant outcome. So at the end it depends on the centers willingness to accept cost and risk – as well as the surgeons’ expertise.

Post written by Dr. Vinay Nair, eAJKD Advisory Board member.

Check out more eAJKD coverage of the NKF’s 2013 Spring Clinical Meetings!

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