*2.6. Kidney Transplantation*

In the past, obesity was a contraindication for kidney transplantation if weight was not reduced. Despite the fact that cut-off limits have increased, even until a BMI of 40 kg/m2, obesity is still one of the leading causes of being inactive on the transplant list. The reason for this is that obese subject recipients of transplantation have increased rates of delayed graft function, wound infection, and rejection.

It is also relevant to note the impact of obesity on the living kidney donor pool and the acceptance of organs from obese subjects. In the former, there is a risk for the donor and recipient, since a mass reduction in an obese subject puts them at risk for future ESKD and in the latter, delayed graft function is more frequent if the donor is obese. According to KDIGO recommendations, an individualized decision should be made for a living donor if the BMI > 30 kg/m<sup>2</sup> due to the risk for future development of hypertension, diabetes as well as ESKD [82].
