Semaglutide enabled 56.5% of obese kidney transplant candidates who had been rejected due to their weight to get listed — and over 60% of those listed were successfully transplanted.
56.5% listed for transplantMore than half of obese kidney patients initially rejected due to weight qualified for the transplant waiting list after semaglutide treatment
What the researchers found
Of 23 obese kidney transplant candidates initially rejected due to obesity, semaglutide treatment (up to 1 mg/week subcutaneously) over a median of 12.2 months produced significant improvements: mean weight decreased by 11.4 kg (p ≤ 0.001), BMI dropped by 3.9 points (p ≤ 0.001), and waist circumference decreased by 9.6 cm (p ≤ 0.001).
56.5% of patients (13 of 23) who had been rejected for transplantation were subsequently listed within a median of 5.4 months. Of those listed, 61.5% (8 patients) were successfully transplanted. No major side effects were reported during the treatment period. Starting weight, BMI, and waist circumference averaged 102.9 kg, 35.6, and 119.5 cm respectively.
Why it matters
Kidney failure patients with severe obesity face a cruel Catch-22: they need a transplant to improve their health, but their weight disqualifies them from surgery. This study shows that semaglutide can bridge that gap safely, opening the door to transplantation for patients who would otherwise remain on dialysis indefinitely. This could change pre-transplant protocols for obese patients at transplant centers worldwide.
How the study worked
This was a retrospective cohort study of patients rejected from kidney transplantation due to obesity between January 2021 and October 2023 at a single transplant center. All patients received subcutaneous semaglutide titrated up to 1 mg/week as part of their pre-transplant weight management. Researchers tracked body weight, BMI, and waist circumference over time, and monitored transplant waitlisting and transplantation outcomes.
What this study cannot tell us
This was a small, single-center retrospective study with no control group. The 23-patient cohort limits statistical power and generalizability. There was no comparison to bariatric surgery or other weight loss interventions. Long-term post-transplant outcomes for semaglutide-treated patients were not reported. The study did not address potential interactions between semaglutide and immunosuppressive medications after transplant.
How to read the evidence
This is a small, single-center retrospective cohort study without a control group. While the clinical outcomes are compelling and statistically significant for weight loss, the study design limits the strength of evidence. Larger prospective trials are needed.
When this study was published
Published in 2025, this is a very current study addressing an urgent clinical need. It reflects the expanding role of GLP-1 agonists in transplant medicine, an area of active investigation.
The bigger picture
GLP-1 receptor agonists like semaglutide are increasingly being used beyond diabetes and general weight management. This study demonstrates a high-impact clinical application: making life-saving organ transplants accessible to patients who were previously excluded due to obesity. As GLP-1 drugs become more available and potentially cheaper with compounding and biosimilars, their role in pre-transplant care could become standard practice — not just for kidney transplants, but potentially for liver and heart transplant candidates as well.
Questions still open
- How do long-term transplant outcomes compare for patients who lost weight via semaglutide versus bariatric surgery?
- Should semaglutide be continued after transplantation to prevent weight regain, and does it interact with immunosuppressive drugs?
- Could higher-dose semaglutide (2.4 mg/week) or tirzepatide achieve even better results in this population?
Common questions
Why are obese patients rejected for kidney transplants?
Why not just do bariatric surgery instead of using semaglutide?
Read the original research
Elective semaglutide prescription enabled waitlisting and transplantation of otherwise ineligible obese renal transplant candidates.
Frontiers in transplantation, 4, 1623096
Citation
Navaux, Emilie; La, Caroline; Dufour, Sylvain; Huberty, Vincent; Mourabit, Youssef; Caes, Thomas; Koliakos, Nikolaos; Mikhalski, Dimitri; Le Moine, Alain; Catalano, Concetta. (2025). Elective semaglutide prescription enabled waitlisting and transplantation of otherwise ineligible obese renal transplant candidates.. Frontiers in transplantation, 4, 1623096. https://doi.org/10.3389/frtra.2025.1623096