Practices in the management of kidney transplant candidates and recipients with obesity: A survey of United States transplant programs

There is growing kidney transplant program-level interest in addressing obesity. The American Society of Transplantation Kidney Pancreas Community of Practice Obesity Work Group surveyed US programs to characterize evaluation, listing, and weight management practices. A web-based survey was administered to professionals involved in kidney transplant care (transplant nephrologists/surgeons/coordinators/dietitians, endocrinologists, bariatric surgeons, and obesity medicine specialists) from May 2024 to September 2024. The 275 respondents from 113 programs represented 70.7% of the US transplant volume. A body mass index (BMI) cutoff—commonly 40 kg/m²—is used for evaluation/listing at 72.5%/74.3% of programs. For recipients, BMI 40 kg/m² was the most common threshold for referral for medical and surgical weight loss. Most (73.4%) programs have weight management programs within their institution; 19.4% have a program integrated into their transplant program. One of the most common reasons for not referring for weight management was a preference that primary care providers/general nephrologists manage this, particularly pretransplant. Of programs, 27.6% offer robotic kidney transplantation; 38.5% offer it only to patients above a BMI threshold (32-40 kg/m²). Obesity management is heterogeneous. Most use a BMI cutoff—typically 40 kg/m²—for evaluation and listing. These data provide the most comprehensive and contemporary overview of practices at US programs.