Do I need to lose weight to get a kidney transplant? Answers to your questions

For many people with end-stage kidney disease, or kidney failure, weight has been a barrier to receiving a kidney transplant. However, many kidney transplant centers and specialists are reexamining traditional weight criteria, opening the path for more people to be candidates for kidney transplantation.

Does weight affect kidney transplant candidacy?

Weight can affect someone’s candidacy for a kidney transplant because of safety concerns over complications, and many kidney transplant centers have a body mass index (BMI) cutoff to be considered for transplantation.

However, the University of Chicago Medicine kidney transplant program takes an individualized approach when evaluating patients and doesn’t use a rigid BMI cutoff. Not only are there better ways to measure health, but recent research suggests patients with higher BMIs have similar outcomes to those with BMIs below the cutoffs of many centers. We also know that people with higher BMIs benefit more from a kidney transplant than they do from remaining on dialysis.

What weight should you be for a kidney transplant?

We encourage patients to ask for a kidney transplant evaluation no matter their weight. We use a thorough examination to understand a patient’s risks and whether they would benefit from transplant.

For patients with higher BMIs, surgeons evaluate how weight is distributed at the site of the surgery and whether that distribution would most likely lead to good outcomes or to complications. One reason why BMI cutoffs are unhelpful to potential transplant recipients is because BMI cannot indicate this weight distribution.

Even if a patient is surgically cleared, we may recommend weight loss if they have chronic conditions that can be caused by weight, like high blood pressure or diabetes. This is in order to decrease other potential health risks.

What if you do need to lose weight for a kidney transplant?

When we recommend weight loss for a patient, we work closely with our UChicago Medicine dietitians to help with safe weight-loss strategies. We don’t want patients to risk their health through harmful means or crash diets, especially if they’re on dialysis. We may also refer patients to the UChicago Medicine Access to Transplant through Novel Approaches to Weight Loss (ACTNOW) Clinic. The ACTNOW Clinic offers a medication-assisted program to help patients get to a safe weight for transplant.

Why do you gain weight after a kidney transplant?

Gaining weight after kidney transplantation can happen, and there are likely factors we still don’t understand. Something we do understand is good news: People feel better after a kidney transplantation, so they regain their appetites. Medications may also play a role in weight gain. But many patients report a return to the weight they were prior to kidney failure.

However, too much weight gain may be harmful if it contributes to diabetes or high blood pressure. Those conditions could affect the health of the transplanted kidney as well as the transplant recipient over the years.

Do you need to be a certain weight to donate a kidney?

Healthy bodies come in all sizes, but we do encourage potential donors with higher BMIs to lose weight before donating a kidney to decrease the risk of complications from surgery. It’s important to keep the remaining kidney as healthy as possible after donation, which means preventing high blood pressure, diabetes and other chronic conditions. There are data to suggest that repeatedly losing and gaining weight is harmful to health, so the goal is to reach a weight that is sustainable. Learn more about kidney donation.

Why should someone consider donating a kidney?

There are approximately 90,000 people on the waitlist for a kidney transplant. Many people find living kidney donation to be a rewarding act of kindness, whether the recipient is a family member, friend or stranger. By decreasing the number of people who need a deceased donor kidney transplant by one, it increases the potential for someone on the deceased donor kidney transplant list to get a kidney.

UChicago Medicine offers the least invasive method of