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Managing the Obese Living Kidney Donor

  • Live Kidney Donation (KL Lentine and R Schaffer, Section Editors)
  • Published:
Current Transplantation Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

In the context of the obesity epidemic, an increasing number of obese individuals present for evaluation as living kidney donor candidates. No standardization exists regarding their selection criteria, evaluation, nephrectomy technique, postdonation follow-up requirements, and predonation weight loss strategies. We review the surgical and long-term medical safety profiles of living kidney donation in obese individuals, address considerations in their evaluation and postdonation follow-up, and explore emerging strategies for predonation weight loss.

Recent Findings

Minimally invasive donor nephrectomy is overall safe in obese individuals, but potentially increases long-term risk of end-stage kidney disease and mortality. Vigilance is needed in the selection, informed consent, counseling, and postdonation follow-up of obese living donors. Lifestyle modification is often inadequate for predonation weight loss, while bariatric surgery is an emerging strategy requiring ongoing studies.

Summary

Careful evaluation, surgical technique, and medical care can support safe living kidney donation in selected obese candidates.

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Abbreviations

BMI:

Body mass index

BPD:

Biliary pancreatic diversion

CKD:

Chronic kidney disease

EBL:

Estimated blood loss

ESKD:

End-stage kidney disease

F:

Female

F/U:

Follow-up

HTN:

Hypertension

KDIGO:

Kidney Disease: Improving Global Outcomes

LOS:

Length of stay

M:

Male

min:

Minutes

mL:

Milliliter

N/A:

Not applicable

NY:

New York

OH:

Ohio

OR:

Operating room

sec:

Seconds

WIT:

Warm ischemic time

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  1. Division of Abdominal Transplant, Department of Surgery, SSM Health Saint Louis University Hospital, Saint Louis University, 3635 Vista Avenue, FDT 11th Floor, Saint Louis, MO, 63110, USA

    Vatche Melkonian & Minh-Tri J. P. Nguyen

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  1. Vatche Melkonian
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Correspondence to Minh-Tri J. P. Nguyen.

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Melkonian, V., Nguyen, MT.J.P. Managing the Obese Living Kidney Donor. Curr Transpl Rep 7, 62–71 (2020). https://doi.org/10.1007/s40472-020-00279-x

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