Kidney transplantation in adult candidates with obesity: Guidelines by the Association Française d'Urologie and Société Francophone de Transplantation

Patients with obesity have a reduced access to kidney transplantation due to the higher risk of surgical and medical complications. Our aim was to provide clinical guidelines in this population focused on: (i) the main anthropometric parameter that contraindicates open kidney transplantation; (ii) other clinical factors to consider before transplantation; (iii) contraindications to robot-assisted transplantation; (iv) efficient and safe weight loss methods for kidney transplantation candidates with obesity.

After a systematic review of studies published between January 2010 and June 2025 performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria, these guidelines were developed by a multidisciplinary task force and reviewed by independent experts.

In total, 153/962 publications met the inclusion criteria. The decision to allow kidney transplantation should not be based solely on Body Mass Index (BMI), but also on skin-to-vessel distance and pelvis angle. Robot-assisted kidney transplantation may be considered in highly selected patients with obesity and limited vascular disease, even those with grade 3 obesity. Patients with frailty should receive appropriate care before weight loss therapies. After appropriate nutritional preparation, bariatric surgery should be considered fairly quickly in patients with kidney failure and grade ≥ 2 obesity (grade B), or grade 1 obesity and poorly controlled type 2 diabetes. While Roux-en-Y gastric bypass achieves superior long-term weight loss than sleeve gastrectomy, it is associated with an increased mortality and morbidity. Pharmacological treatment (mainly GLP-1 agonists) is currently evaluated for weight loss in this population.

These guidelines allow personalizing the management in kidney transplantation candidates with obesity.

Published by The French journal of urology, 2026. The guideline itself is at the source linked here.

doi.org/10.1016/j.fjurol.2026.103100