Kidney transplantation in obese Black patients: Strategies to improve access and outcomes

Abstract

Kidney transplantation (KT) improves quality of life and confers a survival advantage compared to remaining on dialysis in suitable patients with end-stage renal disease. Black patients face challenges, as there are significant disparities in their access to KT and subsequent outcomes compared to other patient groups. This is further exacerbated by the rising prevalence of obesity and consequent health burdens. Controversies exist regarding the eligibility criteria for obese Black patients to undergo KT and factors influencing their long-term outcomes. There is limited evidence in the literature to allow the development of definitive criteria for KT in obese Black patients, given the challenges posed by differences in their genotypic and phenotypic characteristics compared to better-studied populations. There is sparse data on KT programmes for Black population groups in Africa. These patients face challenges such as low socioeconomic status, poor level of education, and awareness of health issues. Even if they do undergo KT, they tend to spend a longer period on dialysis beforehand, leading to poorer outcomes. Further evidence-based data on this patient group are therefore vital to improve their access to KT and subsequent outcomes. This review aims to evaluate the existing evidence, highlight challenges faced by obese Black patients with end-stage kidney disease, and discuss possible strategies to improve both their access to transplantation and subsequent outcomes.

Keywords: Kidney transplantation; Obesity; Black population; Access; Outcomes

Core Tip: Kidney transplantation (KT) is lifesaving as a treatment of kidney failure regardless of race and body habitus. However, long-term data on outcomes in people with obesity who are of Black ethnicity are limited, and this can be a significant deterrent to transplantation in this group. In addition, the available evidence supporting the benefits of KT in the Black population with obesity is controversial. We have reviewed the literature and discuss factors (both modifiable and non-modifiable) affecting access to and outcomes from KT. Issues such as suitable policy changes, better characterisation of Black patients (including genetic studies) and steps to ensure appropriate medication dosing are vital. Emerging medications and new surgical interventions also raise hope in improving access for Black patients.