Obesity and body composition for transplant wait-list candidacy--challenging or maintaining the BMI limits?

Most kidney transplantation programs have a maximum body mass index (BMI) above which they will not place a patient on the active waiting list. However, obesity is common among patients with end-stage renal disease (ESRD), and weight loss is difficult, resulting in many patients being denied the opportunity to be considered for a transplant. BMI limits are in place because of data that outcomes are worse among obese transplant recipients than among those with lower BMI. However, the data to suggest that patient and graft survival are affected by obesity are not consistent, and obese patients with ESRD have better survival after kidney transplantation compared with remaining on dialysis. Therefore, it is important to carefully examine the question of BMI limits to ensure that we are achieving the right balance and making the best use of donated kidneys.