Transplantation. 98(2):167-176, July 27, 2014.
The increase in obesity in the world’s population affects all branches of medicine including transplantation. There is a large literature on the impact of obesity on donation, transplantation and outcomes after transplantation. Nicoletto and colleagues did a literature search in the conventional manner to evaluate the effect of obesity on outcome. In 21 studies, including over 9000 kidney allograft recipients, obesity was associated with an increased risk of delayed graft function (RR1.41); obesity was associated with graft loss and death (particularly from cardiovascular disease) in those studies that evaluated patients before 2000. In another manuscript also in this volume, Huang reports his analysis of the OPTN/UNOS database to determine whether obese patients have deferred listing for active transplantation. Activation was negatively associated with obesity, as were other factors including female gender, diabetic end-stage renal disease, previous renal transplant and high PRA. Many obese status candidates do not achieve active list status. These two studies are amongst several that highlight the impact of obesity on current practice. Sure, clinicians and scientists are getting better at dealing with the negative consequences of obesity but problems remain for the patient. This message needs to be brought not only to patients (who are probably aware but, for many reasons do not or cannot follow advice) but those clinicians caring for patients who are likely to need a transplant so that patients can get a graft when they need it and have a maximum benefit from the graft.