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Kidney transplant: Why obesity is a concern
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Kidney transplant: Why obesity is a concern

Obesity increases the risk of kidney transplantation, health complications after the surgery and impairs the graft function

A kidney transplant is the last resort for people in the advanced stages of chronic kidney disease (CKD). Finding a compatible kidney from a willing donor for a transplant is not the end of all. BMI is one of the prime factors in the kidney transplant checklist. While a body mass index (BMI) of less than 25 is ideal for kidney donation, people with a BMI of 25-30 kg/m2 can also donate kidneys. However, experts strongly advise against donating or transplanting kidneys if the BMI is over 30 and recommend losing weight.

When Suman Agarwal, 45, a homemaker from Ranchi came forward to donate a kidney to her ailing husband in December 2016, she was first advised to shed weight. A battery of tests indicated compatibility, but her BMI was 43 kg/m2 (110 Kilograms). Weight is a key factor for kidney donation or transplant. “Agarwal was advised to reduce at least 20 kilograms to be eligible for kidney donation,” recalls Dr Vivek Pathak, nephrologist and steroids-free kidney transplantation specialist, Kovai Medical Center and Hospital, Coimbatore.

According to Dr Pathak obesity is a concern more among the donors than the renal recipients (1:9). “If I see one person needing kidney transplant battling obesity, there will be nine willing donors who are obese” he said.

Obesity – a risk factor for kidney transplant

Individuals with a BMI of 30 or higher are categorized as obese. Obesity makes an individual ineligible for kidney donation or transplant reception, says Dr Mahesh Prasad, consultant nephrologist PD, Hinduja Hospital and Medical Research Centre, Mahim, Mumbai.

Obesity increases the fat in the lower abdomen. This will necessitate a bigger incision and longer duration for the removal or harvesting of kidneys. “The increased duration of surgery can increase the health complications such as bleeding, and infection during and after the surgery,” warns Dr Prasad.

As observed in a 2020 study, majority of the Kidney donors are women. Dr Prasad points out that among the potential donors, obesity is a problem especially in women aged above 40 years than their male counterparts. “The obesity in these women is mostly linked with declining estrogen in the body due to menopausal transition. When the estrogen hormone reduces, women are at higher risk of developing truncal or abdominal obesity,” explains Dr Prasad.

Obesity and kidney transplant: Risks after surgery

“An increase in the duration of surgery can increase the risk of delayed graft function where the transplant doesn’t start working right away,” explains Dr Prasad. In rare cases, the graft survival of the new kidney may be unsuccessful too, he adds.

Dr Ramachandra P, senior consultant nephrologist, SPARSH hospital, Bangalore cautions physiotherapy and mobility after surgery can become challenging for obese patients and they take a longer time to recover.

Obese and overweight kidney donors are at risk of the following health complications after surgery enumerates Dr Pathak:

Diabetes and blood pressure, caused by obesity, can increase the chances of kidney damage in living donors, warns Dr Pathak. Since they are living with one kidney, extra caution must be exercised to avoid such health risks, says Dr Prasad.

Kidney transplant and lung complications

Kidney transplants can increase the risk of lung complications in obese donors and transplant recipients. Dr Ramachandra explains, “The cramped abdomen due to fat deposits prevents the lungs from expanding optimally in obese individuals.” This increases the risk of pneumonia and pneumothorax or collapsed lung (when air escapes outside the lung),” he adds.

Losing weight for organ donation or transplant reception 

Kidney donors and transplant recipients must always lose weight under expert guidance. Dr Vikram Belliappa, consultant surgical gastroenterologist and hepatobiliary surgeon, Langford Clinic, Bangalore says, that typically these individuals are monitored closely in a weight optimization program. They should be able to lose 1-1.5 kilograms per month and the course is for 3-6 months, subject to the degree of weight loss.”

The weight loss method includes a blend of lifestyle modifications, a nutritious calorie-deficient diet, and regular exercises like walking. One is advised a low carb-high protein diet, says Dr Belliappa. 

However, when individuals need to lose more than 15 kilograms, one is advised to undergo weight loss surgery, says Dr Pathak. Agarwal who was advised to lose a minimum of 20 kilos in three months, opted for sleeve gastrectomy, a surgical procedure that helps reduce weight by limiting the food intake, explained Dr Pathak, who treated the couple. In February 2017, Agarwal, who reduced 20 kilograms, donated her kidney to her husband. The couple has been living a healthy life since then.

Dr Pathak adds that these procedures are adopted in rare cases when losing weight through diet, exercise and lifestyle modifications fails.

Dr Belliappa adds, “Intragastric balloon placement, in which a saline-filled silicone balloon is inserted into the stomach to restrict food intake, is another low-risk and highly effective weight loss surgery for kidney transplant patients.

Experts recommend kidney donors and transplant recipients maintain their weight even after surgery to reduce any health complications. Likewise, the Agarwals have been following a healthy diet and exercise to maintain their weight after the kidney transplant.

Takeaways

  • Kidney donation or transplant reception requires one to have a BMI < 30.
  • Individuals with a BMI > 30 are not eligible for a kidney transplant as it increases the risk of postoperative diabetes, high blood pressure, hypertension and kidney damage.
  • Weight loss measures include lifestyle modifications, a high-protein diet and regular exercise. In rare cases, doctors recommend weight loss surgery.

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