Director of Transplant Surgery, the Saint Barnabas
Health Care System
Obesity is emerging as a serious risk factor in renal transplantation. As the number of overweight Americans has grown in the last several decades and the incidence of renal failure has continued to rise, it is not surprising that kidney transplant centers are treating more patients whose weight poses a threat to their health.
Several studies have compared the outcomes of kidney transplant recipients who are obese (indicated by a body mass index (BMI) of 30 or more), to recipients with a BMI of 25 or less. Results indicate that obese patients suffer significantly more complications after surgery. They are more likely to develop diabetes, high blood pressure or other heart problems, and experience wound complications, leg ulcers and gastrointestinal complications.
Transplant Dietitian, Saint Barnabas Medical Center
Renal and Pancreas Transplant Center
“We do not exclude patients from transplant surgery based on weight alone, but we certainly inform candidates who are carrying excess weight that their risks are increased,” says Stuart Geffner, M.D., Director of Transplant Surgery for the Saint Barnabas Health Care System. “The most common complication our team has seen in this population is poor wound healing. Obese patients are also more likely to experience blood clots and pulmonary embolisms following surgery.
“We strongly recommend transplant candidates to lose weight before surgery,” notes Dr. Geffner. “It is very difficult for someone with chronic illness and who is on dialysis to make a significant weight loss. On the other hand, being a kidney donor can be a motivating factor for a healthy person to lose weight. We have seen several obese donors lose up to 50 pounds in the months before their donor surgery.” Regardless of weight, Dr. Geffner states that most donors are eligible for minimally invasive laparoscopic kidney removal. “The smaller incision and quicker recovery period offer considerable advantages to obese donors.”
Body weight remains an important factor long after transplant surgery. “The average transplant recipient gains 25 pounds in the first six months after surgery,” says Anita Armstrong, R.D., a transplant dietitian at the Saint Barnabas Medical Center Renal and Pancreas Transplant Center. The added pounds are a result of many factors— a less restricted diet once dialysis is stopped, less activity during the post-surgical recovery period, and a combination of immunosuppressive medication that can stimulate the appetite. Ms. Armstrong cautions that obese patients are likely to gain even more weight and continue to gain for up to three years after their transplant.
“One of the most productive things people can do while they are waiting for a transplant is reduce their BMI to less than 25,” stresses Ms. Armstrong. “I tell patients that once you recognize what changes you want to make in your diet, challenge yourself for a week to omit one problem food from your daily diet,” suggests Ms. Armstrong. “Once you accomplish that, omit another problem food the following week. Our taste for fat, sugar and salt are acquired and can be unlearned.”
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