Hospital transplant departments have strict cutoffs for patients with higher body mass indexes because of the increased risk of complications, but GLP-1s such as Ozempic and Wegovy are helping more patients be eligible for surgery.
Potential transplant donors and diabetic patients who otherwise would not be able to undergo surgery because of their BMI are now quickly dropping weight. Popular GLP-1s, including Ozempic, and GLP-1s and glucose-dependent insulinotropic polypeptides, such as Mounjaro and Zepbound, are dramatically helping these weight loss efforts.
At Charleston, S.C.-based MUSC Health, patients who are diabetic and obese are strongly recommended to discuss with their endocrinologists whether GLP-1s can help them achieve a lower BMI.
The system's cutoff for transplant surgery is a BMI of 40 or higher, according to Michael Casey, MD, medical director of kidney transplantation for the health system.
The initiative to promote GLP-1s among diabetic patients on the transplant waitlist is fairly new, he said, as it started about six months ago. Over the last five years, however, his department has grown because "we've been transplanting like gangbusters," Dr. Casey said.
"We've actually had some cases where people could squeak in underneath the wire, like at 39," Dr. Casey told Becker's. "But then, come like six months from now, we find out their BMI goes up to 42. Then we have to inactivate them until they come back down, which for some people can take a long time."
Anecdotally, Dr. Casey said about one-fourth of patients he evaluates have a BMI of 35 or higher, and about 10% of patients do not make the BMI cutoff.
"That's pretty significant [because] we're one of the biggest transplant programs in the Southeast," he said, adding that MUSC Health performs between 300 and 400 transplant operations each year. In 2024, it expects to log 350 — nearly one a day.
Among those with a higher BMI, some cannot lose weight through traditional lifestyle programs, but they also are hesitant to "go under the knife" for bariatric surgery, Dr. Casey said.
In South Carolina, Dr. Casey said he sees a lot of diabetes patients, with a large proportion of Black patients on the kidney transplant waitlist.
"You can see why there's also a little bit of a reluctance to undergo any major surgeries or something like that," he said. "We could claw back a good over 50% of those people that we're potentially losing."
By coordinating with MUSC Health's endocrine and weight loss services, Dr. Casey is working to create a formal protocol. At Houston Methodist, two leaders are piloting one such program.
In the Houston area, patients are waiting seven to nine years for cadaveric transplants, so Julie Corkrean, BSN, RN, and Archana Sadhu, MD, are working to promote living donors. Over the past 12 months, the two fortified a pipeline between the kidney transplant team and endocrinologists.
Ms. Corkrean, director of abdominal transplant and liver center operations, told Becker's some patients are marginally ineligible for transplants, but the last 20 to 30 pounds can be difficult to lose. To get more patients in a safe range — which Houston Methodist defines as a BMI lower than 30 — Ms. Corkrean and Dr. Sadhu collaborate on helping patients with GLP-1 prescriptions and other weight loss strategies.
They have helped about 10 patients become eligible for transplants.
One of Ms. Corkrean's employees "was bound and determined to donate to her best friend," but did not make the BMI cutoff. The program helped her lose weight, and she became eligible to donate. Another patient, who previously had Type 2 diabetes and lost weight but not enough, has lost 40 pounds with the lowest dose of Mounjaro, Dr. Sadhu said.
Dr. Casey and Dr. Sadhu both said they are stringent with which GLP-1s they prescribe, since most of these drugs are approved only for Type 2 diabetes, not weight loss.
"The rising prevalence of obesity just tends to eliminate more and more candidates," Dr. Sadhu said. "In fact, this program will protect two lives. You've got the donor, who is heading toward obesity related chronic conditions that we're helping them lose weight. And then you have the recipient, who obviously worked out with the benefit of a new kidney."
Ms. Corkrean added a third life is helped, too, since a recipient then leaves the cadaveric transplant list, which moves everyone else up.