*Purpose: Our aim was to assess the effect of body mass index (BMI) on the outcomes of renal transplant and the management of obese patients with end-stage renal disease (ESRD) across the UK.

*Methods: We collected data regarding renal transplants during 10 years (2007-2016) from the UK Transplant Registry, excluding paediatric cases and simultaneous transplants with pancreas or liver. We also conducted a national survey sending a questionnaire to the 23 renal transplant centres of the UK, which included 12 questions about the influence of BMI in decision making processes regarding renal transplant.

*Results: 20861 adult renal transplant recipients (men: 61.7%, mean age: 49 years, mean BMI: 26.32) were included. There was a higher risk for DGF and PNF as BMI increased (p<0.0001, p=0.0004), which remained significant in multivariate analysis. 11.6% of recipients lost their graft. Underweight and obese patients had shorter graft survival (p<0.0001). However, only obese recipients had worse graft survival in multivariate analysis. 9.8% of recipients died, 78.3% of them with a functioning graft. There was no significant differentiation in regards to graft survival among the different BMI groups (p=0.278). Nevertheless, underweight recipients had shorter overall survival in multivariate analysis (p=0.021). Concerning our survey, all renal transplant units responded. The median percentage of recipients with BMI≥35% was 15%. Unacceptable BMI was considered a BMI over 35 in 61% of responders and a BMI over 40 in 26% of responders. 14 units suspended their patients when they gained weight above their cut-off limit. However, only one centre refered its patients to weight management.

*Conclusions: Obese recipients are more likely to have DGF and PNF and they have worse graft survival, whereas underweight recipients have worse overall survival. There is also variability concerning the management of obese patients with ESRD across the UK.

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