#2307 Obesity and renal transplantation—a scoping review

Abstract Background and Aims The prevalence of obesity has increased among the general population and individuals with end-stage renal disease (ESRD). Obesity affects the care pathways for kidney transplantation (KT) at pre-, peri-, and post-transplant stages. This scoping review examines the evidence on KT care disparity and outcomes in adults with ESRD and obesity, focusing on: (1) access to the waiting list for KT; (2) post-KT outcomes based on pre-transplant body mass index; and (3) obesity management in transplant recipients. Method Following the Joanna Briggs Institute (JBI) guidelines for scoping reviews, a comprehensive literature search was performed in PubMed, Embase, and Cochrane Library for relevant English-language publications (January 2010 to August 2024). Results The literature search identified 119 publications on waiting-list enrolment for and access to KT, of which seven were included. For post-KT outcomes, 1,147 publications were identified, of which fifty-seven were included. Three hundred and sixty four publications concerning obesity management were identified, and forty-four publications were included, focusing on the pre-, peri-, and post-transplantation management of obesity in transplant recipients. There were disparities in body weight, gender, age, race, and ethnicity for KT waiting-list enrolment and access. In comparison to the recipients without obesity, recipients with obesity had suboptimal post-KT outcomes, including delayed graft function), acute rejection, increased mortality, and higher peri-transplantation complications, i.e., prolonged hospital stay, wound complications, lymphocele, and urinary leaks. However, when compared to remaining on dialysis, they derive survival benefits from renal transplantation. As far as the management is concerned, bariatric surgery, (BS) offers a safe and rapid decline in body weight in renal transplant candidates with morbid obesity. A significant proportion of patients were enlisted and received renal transplantation. BS was also considered safe post renal transplant and resulted in sustainable weight loss. Sleeve gastrectomy was preferred to other forms of BS due to minimal or no impact on immunosuppression kinetics. Lifestyle modifications resulted in modest but unsustainable weight loss. The literature about pharmacotherapies in renal transplant patients is limited. Conclusion This review revealed that patients with ESRD and obesity encounter challenges in being referred and gaining access to renal transplantation. Renal transplant recipients with pre-existing obesity also experience suboptimal clinical outcomes compared with normal-weight recipients. Bariatric surgery is the safest and most effective method for achieving appropriate weight for transplantation. Data on improvements in outcomes following weight loss are limited. It is crucial to assess each patient with ESRD and obesity individually and make risk-informed and unbiased decisions on KT access and care.