Weight Reduction Prior to Kidney Transplantation

The aim of this proposal is to conduct a prospective, randomized trial to assess the effect of weight loss on kidney transplant outcomes. We will test whether weight loss with a fitness program plus diet or bariatric surgery is superior to usual treatment. 

Inclusion Criteria • >Age 18 • Pre-emptive kidney transplant candidates, living related and deceased donors. • Patients that have been on hemodialysis or peritoneal dialysis for more than 6 months. •  

Patients with BMI >40 Intervention Patients will be randomized into one of three arms: 

1. Fitness Program- Patients will be provided with an exercise program and fitness trainer.
2. Bariatric surgery- Patients that qualify and are good candidates for bariatric surgery (restrictive, malabsorptive or combination procedures) will also be enrolled. After 10 months post-bariatric surgery, patients will be selected for kidney transplant surgery. 
3. Control Group- Treatment as Usual (Patient will be provided with information about weight loss programs and plans without direct supervision) 

Primary end points • Delayed wound healing. • Delayed graft function • 1 year graft survival 

Secondary end points • Perioperative complications • Allograft rejection (cellular or antibody-mediated) • Hospital length of stay