BMI, waist circumference and kidney transplantation: Constraints, realities and issues for a specialized obesity center

Abstract

While patients with an end-stage renal disease and living with obesity have a significantly improved prognosis with kidney transplantation, they still face many barriers to access to it. Obesity effect on graft survival and all-cause survival is less and less established. However, questions about immunosuppressive drugs management, post-transplant diabetes and glomerular hyperfiltration syndromes remain an issue. Nevertheless, surgical gesture remains the main barrier. Complications from surgery still restrain registration. At the same time, pre-registration weight-loss programs under dialysis face an excess of mortality. Bariatric surgery issue for people with the highest BMIs might be a solution that still needs more research. Exercise rehabilitation during dialysis programs are also major avenues that need further explorations. Finally, robot-assisted surgery arrival could remove many restrictions. These surgical notions also lead us to wonder whether BMI is the right indicator. Isn't the waist circumference, a direct reflection of the abdominal apron, the blocking element for surgery? In any case, the French National Authority for Health currently only sets a limitation on kidney transplantation for BMIs above 50 kg/m2. This rule is still far from being a reality for people living with obesity in France and around the world.