Key result
While 68.6% of German transplant departments use absolute BMI thresholds for kidney transplant waitlist access, only 41.2% evaluate candidates with obesity for bariatric surgery by default.
Why the study?
Obesity is linked to inferior kidney transplant outcomes and often restricts access to transplantation, but whether bariatric surgery benefits patients on the waiting list remains unclear.
Cross-Sectional (n=51)
Yes
Despite commonly used BMI limits restricting access to kidney transplantation, only a few German centers routinely consider bariatric surgery for obesity treatment in these candidates.
BMI thresholds commonly restrict KT access; leaves open whether bariatric surgery integration can safely expand eligibility.
BACKGROUND: Obesity in the recipient is linked to inferior transplant outcome. Consequently, access to kidney transplantation (KT) is often restricted by body mass index (BMI) thresholds. Bariatric surgery (BS) has been established as a superior treatment for obesity compared to conservative measures, but it is unclear whether it is beneficial for patients on the waiting list. METHODS: A national survey consisting of 16 questions was sent to all heads of German KT centers. Current situation of KT candidates with obesity and the status of BS were queried. RESULTS: (45.1%; n = 23/51) as the most common threshold. BS was considered an appropriate weight loss therapy (92.2%; n = 47/51), in particular before KT (88.2%; n = 45/51). Sleeve gastrectomy was the most favored procedure (77.1%; n = 37/51). Twenty-one (41.2%) departments responded to evaluate KT candidates with obesity by default but only 11 (21.6%) had experience with ≥ n = 5 transplants after BS. Concerns against BS were malabsorption of immunosuppressive therapy (39.2%; n = 20/51), perioperative morbidity (17.6%; n = 9/51), and malnutrition (13.7%; n = 7/51). CONCLUSIONS: Obesity is potentially limiting access for KT. Despite commonly used BMI limits, only few German centers consider BS for obesity treatment in KT candidates by default. A national multicenter study is desired by nearly all heads of German transplant centers to prospectively assess the potentials, risks, and safety of BS in KT waitlisted patients.
No takes yet. Share an insight, caveat, or question.
Dziodzio et al. (2022) conducted a cross-sectional in End-stage renal disease with obesity (n=51). Survey on BMI thresholds and bariatric surgery practices was evaluated on Proportion of centers using BMI thresholds and considering bariatric surgery. While 68.6% of German transplant departments use absolute BMI thresholds for kidney transplant waitlist access, only 41.2% evaluate candidates with obesity for bariatric surgery by default.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: