Are some patients too heavy for a new kidney?

IN A RESEARCH review article* published in the American Journal of Nephrology, Saint Louis University investigators examined data from multiple studies to better understand how obesity, an epidemic in the U.S., impacts kidney transplant patients. The authors report that, even as some connections between weight and health outcomes are unknown or contradictory, there is evidence that obese kidney transplant patients don’t do as well after surgery, experiencing more adverse outcomes, including wound infections, delayed graft function, graft failure, cardiac disease and increased costs.

Led by Krista Lentine, M.D., associate professor of internal medicine in nephrology and Betsy Tuttle-Newhall, M.D., director of abdominal transplant at SLU, the authors examined multiple studies and concluded that the health outcomes of patients with higher body mass indices (BMI) are not as good. In addition, they found several areas where more study is needed in order to make clear and consistent recommendations about kidney transplants for heavier patients.

“Lifestyle alterations that seem reasonable to improve health outcomes should be encouraged,” Tuttle Newhall said. “Just as we require patients with alcoholic liver disease to stop drinking prior to transplant, it is reasonable to ask kidney transplant candidates to lose excess body fat and attempt to increase lean muscle mass by becoming more physically active and modifying their diet.”

Lentine, who also holds an appointment in the Saint Louis University Center for Outcomes Research (SLUCOR), says the study points the way for future research to fill in gaps in our knowledge about how weight affects kidney transplant patients.

“Current guidelines from the American Society of Transplantation recommendAir Jordan VI Low