Weight Gain after Transplant: A Dietitian Weighs In

By Janelle E. Gonyea, R.D., L.D

Did you gain weight post-transplant? You’re not alone. Excessive weight gain is a common concern after receiving a transplant, as it affects about two thirds of all kidney transplant recipients.1 Post-transplant weight gain is also common with other solid organ transplants.

There are many reasons why people gain weight after receiving a transplant. For kidney patients, the pre-transplant diet can be very restrictive so people sometimes gain weight once they are able to eat a wider variety of foods. Additionally, people may have a better appetite after transplant, leading them to consume more food (and calories) than before. The immunosuppressant medications necessary to prevent organ rejection can also contribute to weight gain. If you experienced difficulty with malnutrition and weight loss pre-transplant, the weight gain may be positive, but be sure not to tip the scale beyond what your health provider considers a healthy weight for you.

Gaining excess weight after transplant can lead to other serious, long-term diseases. These include:

  • Type 2 diabetes – also sometimes called “adult onset diabetes,” in Type 2 diabetes the body loses its ability to produce insulin and/or the cells ignore the insulin that the body is producing which results in higher blood sugar levels. Diabetes can lead to other complications such as problems with vision, nerve damage (especially in the feet and legs) and kidney failure. Hormones produced by fat tissue have been linked to the onset of Type 2 diabetes.
  • Gout – is a painful disease that occurs when uric acid, a normal waste product, builds up in the blood and forms crystals in the joints and/or kidneys.
  • Heart disease and strokes – research indicates that for each 10% increase in body weight, there is about a 20% increase in coronary artery disease.
  • High cholesterol – when people are overweight, their body produces additional cholesterol daily (in addition to any cholesterol consumed through foods).
  • Hypertension (high blood pressure) – a leading risk factor for heart disease, stroke and kidney disease. Even a modest weight gain can raise blood pressure. After transplant, it is especially important to monitor your blood pressure levels because immunosuppressant medications and changes in your hormonal balance and blood vessels place you at greater risk.
  • Liver disease – the weight gain you see in the mirror also exists on the inside. Fat cells can deposit inside organs such as your liver and this may cause the liver to work less effectively. As more and more fat is deposited, serious liver conditions can develop, including liver failure.
  • Osteoarthritis – often referred to as "wear and tear" arthritis. Over time the joint cartilage wears down, resulting in bone-to-bone contact that can cause pain and eventually loss of mobility. This condition is common in those who are overweight because the weight causes increased stress on many joints, such as the knees and back.
  • Sleep apnea – a condition where one wakes up from sleep to catch their breath. Snoring is a common sign of sleep apnea and the sleeper may stop breathing for up to a minute at a time. Sleep apnea increases the chances of fatal heart attacks. People also tend to wake up when breathing resumes, often several times a night. This leads to daytime fatigue and sleepiness. Chronic fatigue weakens the immune system, increasing health risks.

For more information on these conditions, please visit the National Kidney Foundation’s A to Z Health Guide.

  1. Jezior D, Krajewska M, Madziarska K, et al: Posttransplant Overweight and Obesity: Myth or Reality?. Transplant Proc, 2007. 39:2772-2775.
  2. The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. NHLBI Obesity Education Initiative. October 2000