DEAR MAYO CLINIC: My kidneys are failing, and my doctor has told me that I need to have a kidney transplant. I am severely overweight, and losing weight has been extremely difficult. Due to my weight, my doctor also said that I would not qualify for a transplant. What options are available for patients who are overweight and in need of a transplant?
ANSWER: You are not alone in your struggles with weight. More than 40% of adults in the U.S. are obese, according to the Centers for Disease Control and Prevention. Statistics also show that a growing number of kidney transplant candidates have morbid obesity, meaning they have a body mass index, or BMI, of 35 or higher.
BMI is a tool used to define when a person is overweight or obese based on weight and height. Many transplant centers will not perform kidney transplants on people with a BMI above 35 due to the increased risks of complications. Some transplant centers will perform surgeries on patients with a BMI of up to 40.
That still leaves a sizable number of patients who are obese and in need of a transplant who do not qualify. In the past, these patients were often told to lose the necessary weight on their own and return to qualify for a transplant when they had reached their goal weight.
The good news is transplant patients who need to lose weight to qualify for a transplant now have more options.
Some transplant centers, including Mayo Clinic, have begun offering programs designed to help patients awaiting a transplant lose weight. People who participate in these programs may work with a team, including dieticians, endocrinologists, psychologists and others to create a detailed weight-loss plan.
While some patients successfully lose the necessary weight to qualify for a transplant through diet and exercise alone, other people may undergo bariatric surgery to help them lose the weight necessary to qualify for a lifesaving transplant. The two most common types of bariatric surgery are Roux-en-Y gastric bypass and sleeve gastrectomy.
The first procedure involves creating a small pouch from the stomach and connecting the newly created pouch directly to the small intestine. In the case of a sleeve gastrectomy, a surgeon removes about 80% of the stomach, leaving a long, tubelike pouch.
Most bariatric procedures are performed laparoscopically. This minimally invasive technique shortens recovery times. As with any surgical procedure, risks are involved, so it is important for patients to discuss the pros and cons of each procedure with their health care provider. In addition, patients who undergo bariatric surgery need to be willing to make permanent healthy lifestyle changes for the procedure to be successful.
Patients who are obese and in need of an organ transplant often struggle with other chronic conditions, including obstructive sleep apnea and Type 2 diabetes. Losing weight can sometimes cure these ailments, which lowers the risk in undergoing transplant surgery. It also increases the odds for better outcomes posttransplant.
Recognizing the need for weight loss and asking for assistance early is the most important thing patients who are obese can do as they begin navigating kidney transplant options. Once a patient ends up needing dialysis, losing weight gets harder because the treatment causes fatigue.
While having to lose a large amount of weight to qualify for a transplant may seem overwhelming, remember experts and resources are out there to help with this challenge. — Dr. Aleksandra Kukla, Nephrology, Mayo Clinic, Rochester, Minnesota
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