Obesity in kidney transplant donors and recipients: does the benefit outweigh the risk?
Integrative Obesity and Diabetes
Overweight and obesity has reached epidemic proportion worldwide and has been described as a global pandemic. Obesity is recognized as a major and independent risk factor for cardiovascular death and its prevalence has risen dramatically over the past two decades. Similar to the general population, patients with chronic kidney disease are also increasingly obese. Contrarely, in patients with ESRD the reverse epidemiology of the obesity paradox seems to protect the hemodialysis population from
... s population from cardiovascular death. Among kidney transplant recipients, overweight and obesity prevalence has risen with 60% of kidney transplant candidates being overweight or obese at the time of transplantation. Though recipient obesity negatively impacts the access to transplantation, after transplantation, short and long term outcomes are very good. The surgical procedure is not associated with major complications or death. Short term outcomes are excellent except an increased incidence of delayed graft function while long term there is a definite survival advantage compared to HD. Furthermore, prevalence of overweight and obesity rises in living kidney donors similar to the general population. Obesity related glomerulopathy, a variant of focal and segmental glomerulosclerosis, is the clinicopahtologic entity that best describes the process of kidney damage in obese individuals. Since thepathophysiologic process is similar to that of secondary FSGS due to reduced nephron mass, it may be accelerated after kidney donation. In the absence of definite guidelines, overweight donors must be informed about the increased risk of donation and obese (BMI>30 Kg/m 2 ) donors have to be excluded from donation, at least until they lose weight. Undoubtedly the transplantation community faces a new, emerging problem: the definite advantage of survival following renal transplantation and the dramatically increased prevalence of overweight and obesity between transplant recipients and donors.