Practices in the management of kidney transplant candidates and recipients with obesity: A survey of United States transplant programs

Chethan M Puttarajappa; Megan Urbanski; M Kazem Fallahzadeh; Pooja Budhiraja; Vasanthi Balaraman; W Scott Butsch; Harry Morford; Prince M Anand; Kenneth J Woodside; Babak J Orandi; co-authors

doi:10.1016/j.ajt.2025.05.033

Practices in the management of kidney transplant candidates and recipients with obesity: A survey of United States transplant programs

Am J Transplant. 2025 May 31:S1600-6135(25)00290-4. doi: 10.1016/j.ajt.2025.05.033. Online ahead of print.

Collaborators

co-authors:
Ahmed Abdelkader¹⁰, Faris Ahmed¹¹, Abbas Al-Kurd¹², Melissa Albritton¹³, Sandiya Bindroo¹⁴, Andrew Brown¹⁵, Adrian Carlson¹⁶, Nadiesda Costa¹⁷, Iris de Castro¹⁸, Antionio di Carlo¹⁹, Imran Gani²⁰, Jashalynn German²¹, H Stephen Han²², Sabiha Hussain²³, Syed Hussain²⁴, Courtney Kelley²⁵, Vineeta Kumar²⁶, Krista Lentine²⁷, Swee-Ling Levea²⁸, Mary Ann Lim²³, Yee Lu¹⁴, Hector Madariaga²⁹, Shikha Mehta²⁶, Vivek Moorthy¹³, Aparna Padiyar³⁰, Nisha Patel³¹, Karthik Ramanathan³², Karthik Ranganna²³, Sima Saberi¹⁴, Anushi Shah³³, Pritika Shrivastava³⁴, Manpreet Singh³⁵, Priya Singh³⁶, Meredith Skulski³⁷, Meaghan Stumpf³⁸, Faizan Syed³⁵, Julie Yabu³⁹, Anju Yadav⁴⁰

Affiliations

¹ Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
² Department of Surgery, Emory University, Atlanta, Georgia, USA.
³ Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
⁴ Department of Internal Medicine, Mayo Clinic College of Medicine and Science, Phoenix, Arizona, USA.
⁵ Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
⁶ Department of Surgery, Cleveland Clinic, Cleveland, Ohio, USA; Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA; Department of Geriatrics, Cleveland Clinic, Cleveland, Ohio, USA.
⁷ Department of Medicine, Medical University of South Carolina, Lancaster, South Carolina, USA.
⁸ Gift of Life Michigan, Ann Arbor, Michigan, USA.
⁹ Department of Surgery, New York University, New York, New York, USA; Department of Medicine, New York University, New York, New York, USA. Electronic address: Babak.Orandi@nyulangone.org.
¹⁰ Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
¹¹ Department of Medicine, Cleveland Clinic Foundation Abu Dhabi, Abu Dhabi, United Arab Emirates.
¹² Department of Surgery, Henry Ford Hospital, Detroit, Michigan, USA.
¹³ Department of Medicine, Willis Knighton Health System, Shreveport, Louisiana, USA.
¹⁴ Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA.
¹⁵ Department of Transplant Pharmacy, Virginia Commonwealth University, Richmond, Virginia, USA.
¹⁶ Department of Pharmacy, Medical University of South Carolina, Lancaster, South Carolina, USA.
¹⁷ Department of Medicine, Georgetown MedStar, Washington, DC, USA.
¹⁸ Department of Medicine, University of Washington, Seattle, Washington, USA.
¹⁹ Department of Surgery, Temple University, Philadelphia, Pennsylvania, USA.
²⁰ Department of Medicine, Medical College of Georgia, Augusta, Georgia, USA.
²¹ Department of Medicine, Duke University, Durham, North Carolina, USA.
²² Department of Medicine, Dell Seton Medical Center at the University of Texas Austin, Austin, Texas, USA.
²³ Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
²⁴ Department of Medicine, University of Texas Medical Branch, Galveston, Texas, USA.
²⁵ Department of Medicine, University of Chicago, Chicago, Illinois, USA.
²⁶ Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
²⁷ Department of Medicine, St. Louis University, St. Louis, Missouri, USA.
²⁸ Department of Medicine, University of Texas Southwestern, Dallas, Texas, USA.
²⁹ Department of Medicine, Lahey Clinic, Burlington, Massachusetts, USA.
³⁰ Case Department of Medicine, Western Reserve University/University Hospital, Cleveland, Ohio, USA.
³¹ Department of Surgery, California Pacific Medical Center, San Francisco, California, USA.
³² Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
³³ Department of Surgery, Integris Oklahoma, Oklahoma City, Oklahoma, USA.
³⁴ Department of Medicine, Henry Ford Hospital, Detroit, Michigan, USA.
³⁵ Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
³⁶ Department of Medicine, Ohio State University, Colombus, Ohio, USA.
³⁷ Dell Seton Medical Center at the University of Texas Austin, Austin, Texas, USA.
³⁸ Department of Medicine, University of Virginia, Charlottesville, Virginia, USA.
³⁹ Department of Medicine, University of California Los Angeles, Los Angeles, California, USA.
⁴⁰ Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.

PMID: 40456410
DOI: 10.1016/j.ajt.2025.05.033

Abstract

There is growing kidney transplant program-level interest in addressing obesity. The American Society of Transplantation Kidney Pancreas Community of Practice Obesity Work Group surveyed US programs to characterize evaluation, listing, and weight management practices. A web-based survey was administered to professionals involved in kidney transplant care (transplant nephrologists/surgeons/coordinators/dietitians, endocrinologists, bariatric surgeons, and obesity medicine specialists) from May 2024 to September 2024. The 275 respondents from 113 programs represented 70.7% of the US transplant volume. A body mass index (BMI) cutoff-commonly 40 kg/m²-is used for evaluation/listing at 72.5%/74.3% of programs. For recipients, BMI 40 kg/m² was the most common threshold for referral for medical and surgical weight loss. Most (73.4%) programs have weight management programs within their institution; 19.4% have a program integrated into their transplant program. One of the most common reasons for not referring for weight management was a preference that primary care providers/general nephrologists manage this, particularly pretransplant. Of programs, 27.6% offer robotic kidney transplantation; 38.5% offer it only to patients above a BMI threshold (32-40 kg/m²). Obesity management is heterogeneous. Most use a BMI cutoff-typically 40 kg/m²-for evaluation and listing. These data provide the most comprehensive and contemporary overview of practices at US programs.

Keywords: bariatric surgery; kidney transplant; obesity; survey.