An innovative weight loss program for obese patients requiring kidney transplantation

Infection, delayed kidney function, kidney loss, and death are all risks associated with kidney transplant surgery in obese patients.

They are also some of the reasons why end-stage renal disease patients with over 40 BMIs often struggle to be listed for transplants.

New data from the comprehensive transplant center at Ohio State University Wexner Medical Center show obese patients with end-stage renal disease, and diabetes can use weight loss injections to drop the pounds that need to be placed on the transplant weight list.

“When a patient is postponed due to weight, many people are not transplanted because of traditional weight loss methods and there is a long wait for bariatric surgery,” says Priya Singh, a transplant nephrologist at Wexner Medical Center in Ohio, and is a clinical associate professor of clinical medicine at Ohio University School of Medicine.

“There are studies showing that glucagon-like peptide-1 (GLP-1) drugs are safe and effective among the general population and patients with chronic kidney disease.”

Formed in March 2024, the comprehensive transplant center's kidney transplant weight loss program uses a combination of diet, exercise, counseling and weight loss injectables to help patients achieve their weight loss goals and qualify for transplants.

Referral criteria include a BMI of 38 or higher and a weight loss requirement of less than 40 pounds. Type 1 diabetes, gastrointestinal problems, history of pancreatic cancer, and multiple endocrine neoplasms 2 patients are not eligible.

Researchers followed six kidney transplant candidates over a 12-month period. Five patients were on dialysis, and one had five stages of chronic kidney disease. The median BMI was 39.5 and the median weight was 277.5 pounds. The median weight loss was 27.5 pounds.

Patients took semaglutide or tilzepatide based on insurance coverage. They were counseled about diet and exercise and were monitored by a nutritionist.

“All patients tolerated the drug with no side effects for kidney function and no dose adjustment was required,” Singh said.

Each patient achieved weight loss goals. The median weight was 246 pounds after patients began taking GLP-1, and the median BMI was 35.6. Of the six patients, three have been successfully implanted, and three are active on the transplant waitlist. The average time to reach the desired weight and BMI for six approved patients was 135 days.

The results of this program are the next step in Singh's study on the use of GLP-1 in kidney transplant recipients with type 2 diabetes. Inadequate management of diabetes is detrimental to the long-term survival of the transplanted kidneys, increasing the risk of heart disease and death.

Since 2018, Singh has been studying the ability of GLP-1, supporting healthy glucose levels and weight loss, reducing the need for insulin without interfering with immunosuppressive drugs in solid organ transplant patients.

Singh did this through a retrospective chart review of adult kidney transplant recipients with type 2 diabetes who were in GLP-1. Recipients were tracked at 6, 12, 36, and 60 months. They maintained a significant decrease in body weight, BMI and blood sugar levels.

Weight loss was 2.6 pounds per year, 8 pounds at three years and 9 pounds at five years compared to baseline. With the use of GLP-1, major harmful cardiac events decreased from 45.5% to 18.9%, and median insulin needs decreased from 50 to 27 units at the end of five years.

“Obesity is a lifestyle illness and it can be very difficult to maintain weight loss,” Singh said. “I always tell patients in the clinic that it's diet, exercise and that only then does the medication work.”

Future studies of Singh will discuss the safe use of GLP-1 drugs in other types of organ transplant recipients.