Obesity in Living-Donor Kidney Transplant: What Risks for the Donor and the Recipient?

Abstract

For a kidney transplant candidate, a living-donor kidney transplant is the best option: it offers the longest survival to the recipient. Currently, more than 27000 living-donor kidney transplants are done each year in the world. More than 25% of all living kidney donors are now considered obese at the time of donation compared with fewer than 8% in the 1970s, and the proportion of obese recipients is doubling every 15 years as a result of the global epidemic of obesity. Obesity exposes both the donor and recipient to multiple complications: first, of an immediate surgical nature in the intra- and postoperative periods, then of a medical nature in the short and long term. Although surgical complications are well known and better mastered thanks to great technical progress, long-term medical complications can be severe and compromise patient survival and that of the transplanted kidney. For the recipient, the benefits of kidney transplant compared with end-stage renal disease are significant despite all the risks and complications caused by obesity. For the donor, however, no risk of severe complications is acceptable, and the main objective of pretransplant explorations is to ensure that the donation of a kidney occurs in complete safety for the donor. In the presence of obesity, if the donor is highly motivated and barring other exclusion criteria, it is mandatory to clearly inform the donor of all potential obesity-related risks, to strongly encourage him/her to lose weight before the donation, and to maintain this weight afterward.