The conundrum of high body mass index in kidney transplant patients

Obesity is on the rise and the number of end stage renal disease patients who are obese parallel this trend. There is no universally accepted guideline for wait-listing end stage renal disease obese patients in order to reduce surgical complications and improve survival of the kidney graft. Criteria for acceptance are variable among transplant centres, as do post-transplant policies. Careful risk assessment to maximise the benefits of the limited organ donor resource must be undertaken prior to waitlist an obese kidney transplant candidate. Likewise, close post transplantation follow-up for this higher risk group should be implemented as per the general population, but the body mass index per se should not be a barrier to get access to transplantation.