Management of Weight Loss After Kidney Transplantation?
Is there a safe drug for managing overweight/obesity after kidney transplantation?

There are 3 major weight loss medications approved by the US Food and Drug Administration. They are sibutramine (Meridia), phentermine hydrochloride (various generic products), and orlistat (Xenical). There are no controlled studies of these agents in transplant recipients. Sibutramine may be safe for transplant recipients, but is metabolized in the P450 3A4 system and may interfere with cyclosporine, tacrolimus, or rapamycin metabolism. As with all serotonin uptake inhibitors, rare cases of pulmonary hypertension may occur. Phentermine may also cause modest weight loss in transplant recipients. It was more effective when used in combination with fenfluramine, but it has been removed from the US market due to concern about pulmonary hypertension and valvular abnormalities. Finally, orlistat may be effective, but it inhibits fat malabsorption and can reduce cyclosporine or tacrolimus levels.

Obesity after transplantation is a major clinical issue and often is the most significant complaint for most posttransplant patients. In my experience, structured weight loss programs have been most effective in allowing recipients to lose weight. I have also seen some significant weight loss from the Atkins diet in some of my patients. As with any weight-loss program, careful monitoring for side effects is essential.