Ohio State Introduces Innovative Weight Loss Program for Obese Patients That Need a Kidney Transplant | Newswise

Newswise — COLUMBUS, Ohio – Infection, delayed kidney function, kidney loss and death are all risks associated with kidney transplant surgery in obese patients.

They’re also some of the reasons why end stage kidney disease patients with a BMI greater than 40 often struggle to be listed for transplant.

New data from The Ohio State University Wexner Medical Center Comprehensive Transplant Center shows obese patients with end stage kidney disease and diabetes can safely use weight loss injections to drop the pounds needed to be placed on the transplant waitlist.

“When patients are deferred because of their weight, many never get transplanted because they’re not able to lose weight through traditional weight loss methods and there could be a long wait time for bariatric surgery,” said Priya Singh, MBBS, transplant nephrologist at Ohio State Wexner Medical Center and clinical associate professor of internal medicine at The Ohio State University College of Medicine. “There are numerous studies in the general population and among patients with chronic kidney disease that show glucagon-like peptide-1 (GLP-1) medications are safe and effective for weight loss.”

Formed in March 2024, the Comprehensive Transplant Center’s kidney transplant weight loss program uses a combination of diet, exercise, counseling and weight loss injection medication to help patients reach weight loss goals to make them eligible for transplantation. Criteria for referral include a BMI of 38 or greater and a weight loss requirement of less than 40 pounds. Patients with type 1 diabetes, gastrointestinal issues, a history of pancreatic cancer and multiple endocrine neoplasia-2 are not eligible.

Researchers followed six kidney transplant candidates over 12 months. Five patients were on dialysis and one had stage 5 chronic kidney disease. The median BMI was 39.5 and the median weight was 277.5 pounds. The median weight loss requirement was 27.5 pounds.

The patients took semaglutide or tirzepatide based on insurance coverage. They were counseled on diet and exercise and monitored by a dietitian.

“All of the patients tolerated the medications without any side effects and no dose adjustments were required for kidney function,” Singh said.

Each patient achieved their weight loss goal. The median weight after the patients started taking GLP-1s was 246 pounds and the median BMI was 35.6. Three of the six patients have been successfully transplanted and three are active on the transplant waitlist. The average time to reach the desired weight and BMI for the six approved patients was 135 days.

The results of this program are the next step in Singh’s research into the use of GLP-1s in kidney transplant recipients with type 2 diabetes. Poorly controlled diabetes is detrimental to the long-term survival of the transplanted kidney and increases the risk of heart disease and death. Since 2018, Singh has been studying the ability of GLP-1s to support healthy glucose levels and weight loss and reduce the need for insulin without interfering with immunosuppressant medications in solid organ transplant patients.

Singh did this through a retrospective chart review of adult kidney transplant recipients with type 2 diabetes who were on GLP-1s. The recipients were followed at six, 12, 36 and 60 months. They sustained significant reductions in weight, BMI and blood sugar levels. The weight reduction was 2.6 pounds at one year, 8 pounds at three years, and 9 pounds at five years compared with the baseline. With GLP-1 use, major adverse cardiac events decreased from 45.5% to 18.9%, and the median insulin need decreased from 50 to 27 units at the end of five years.

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

Singh’s future research will look at the safe use of GLP-1 medication in other types of organ transplant recipients.

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