*Purpose: Obesity causes and complicates glomerulonephritis and chronic kidney disease (CKD) leading to end stage renal disease (ESRD). Kidney Transplantation (KT) improves ESRD patients’ survival and quality of life, but to a lesser extent if obese given increased allograft failure and mortality risks. At our center, obesity is a major basis for inactive status. Obesity management in CKD has not been standardized.

In 2018, counseling and follow up of patients with obesity (BMI>35) yielded minimal change. We have since launched a multistep weight loss intervention algorithm and aim to determine its effectiveness along with identification of major barriers for KT candidates with obesity (KTCwO).

*Methods: Since April 2019, newly referred KTCwO (BMI>38) are enrolled with informed consent into IRB approved prospective study-. A structured protocol initiated by registered dietician and transplant surgeon at initial visit with nutrition/motivation/frailty assessments, weight loss education and establishment of goal weight loss >5% over 6-month period to achieve BMI<38, counseling on food regimens, home tracking/app devices, and introduction to weight center with referrals. Follow up consisted of monthly phone calls with intervention checkpoints at 6 and 12 months.

*Results: Our initial 2018 support process review yielded 87 KTCwO. 36 of them achieved minimal weight loss while 22 gained weight, with no change in percent of wait list patients inactive due to obesity. Since the multistep algorithm introduction, 28 listed inactive KTCwO enrolled. 11 of them with less than 6-month follow up were excluded from analysis. 7/17 patients have achieved weight loss with >2 follow up encounters since initial evaluation. 3 patients have implemented diet and exercise regimens and 4 patients have been referred to weight center. Of the weight center referrals, one patient is managed with medication and three have been referred for bariatric surgical evaluations.

*Conclusions: While in preliminary stages, multidisciplinary intervention initiation with assistance of weight center has resulted in KTCwO benefit. We recognize the limitations of time and power in our data along the ongoing identification of barriers in enrolled patients. Continued follow up with individualized checkpoint interventions and accrual of more patients will yield promising outcomes for KTCwO.

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