Weight Gain After Transplant: Where Does it Come From and How to Get Rid of It

Many factors can contribute to unwanted weight gain after your transplant. However, carrying around excess weight is unhealthy for post-transplant patients: it can hinder your recovery following surgery by slowing down healing, and it also may put you at higher risk for diseases or complications that stem from being overweight, such as diabetes, heart disease, hypertension, non-alcoholic fatty liver disease or even certain cancers.

“Unwanted or unneeded weight gain is common, though the reasons why and amounts vary based on the organ transplanted,” says Heather Bamlet, RDN, LD, transplant clinical dietitian at Mayo Clinic’s campus in Rochester, Minn. “I think based on the numbers, it is safe to say many transplant patients gain between 10-20 pounds—but this does not have to happen. If it does occur, patients can successfully lose weight, if they are committed.”

Causes of Weight Gain

Here are some factors that may contribute to putting on pounds following transplant:

• Reducing activity level due to recovery or feeling afraid of hurting the new organ
• Not needing as many calories with a healthier body that works more efficiently post-transplant
• Experiencing medication side effects, such as fluid retention or decreased metabolic rate
• Seeing an increased appetite after surgery due to overall feeling better
• Rewarding yourself with foods that were restricted before surgery, such as ice cream
• Choosing more fattening “comfort foods” to make yourself feel better as you heal from transplant
• Experiencing more opportunities for overeating as you become more social again, such as eating out, celebration events and traveling
• Exceeding your weight-gain goal if you’ve been advised to put on weight due to losing too much weight pretransplant

Typical Weight Gain Patterns

Here Heather shares with us common patient experiences as well as the numbers for weight gain, by transplant type:

Heart: Weight gain often occurs after heart transplant, which is likely due to feeling better and a less restricted diet. A small, retrospective study on 200 heart transplant patients showed recipients had gained an average of 22.7 pounds one year out from transplant.

Kidney: A small study including 35 post-kidney transplant patients showed that more than half, or 19 of 35 of the study participants, gained weight following kidney transplant, while the others maintained or lost weight after transplant. For those who gained weight, the average increase was 19.58 pounds. Those who ate more fruits and vegetables, however, tended to experience less weight gain. Another study showed average weight gain of about 9 percent three years post-transplant.

Liver: Though liver transplant patients are likely to see some weight loss initially, weight gains can start around four months after surgery. Patients are told to eat to help with the healing process, and some even need to gain weight and muscle mass lost prior to transplant. Often they feel so much better post-transplant, however, with food tasting good and appetite increasing, that they put on pounds. One study showed a median weight gain of 11.24 pounds at one year after liver transplant and a 20.94-pound weight increase three years after transplant.

Lung: This patient group tends to be more diverse in terms of weight gains and losses. Some may have lost significant weight and muscle mass before transplant, and so their providers encourage regaining these after surgery. Others gain weight due to changes in activity levels. In the longer term following lung transplant, some patients see weight increase, while others see muscle mass losses due to steroid use. Researchers found the median weight change after transplant was 10 percent.

How to Lose Post-Transplant Weight

Do transplant patients have a unique situation for weight loss? Yes and no, Heather says. Though their circumstances surrounding weight gain may be distinct, the basics of weight loss are similar to others needing to lose excess pounds.

“Our transplant patients have been through a lot—and likely a dramatic life change after surgery and recovery,” Heather says. “However, when you break it down, if someone is gaining weight, they have reached a point where too many calories are going in and not enough calories are being burned off.”

Regardless of your transplant type and how you may have gained weight after it, here are some tips on how to see the scale go down:

Cooking and Meal Planning

1. Plan meals ahead of time.
2. When designing a meal, follow the MyPlate method.
3. Use cooking methods that will keep the foods out of reach for snacking, such as a slow cooker.

Eating

1. Be aware of your portion sizes.
2. Eat more fruits and vegetables.
3. Choose whole grains, lean meats and low-fat dairy products most often.
4. Keep treats like cake, candy, cookies, chips or soda to a minimum.
5. If still hungry after meals using the MyPlate method, reach for more fruits and vegetables.
6. Make sure you are drinking enough noncaloric fluids.

Exercise

1. Get active. Aim for at least 150 minutes of exercise weekly. It is better to split this up and do at least 20 minutes most days of the week.
2. Do weight training. Add this in to boost your muscle mass after your surgeon clears you to do so, since muscle burns more calories at rest than fat does.

Accountability, or having someone to whom you report your weight loss progress, is also an important component of success.

An ideal body mass index target is 18.5-24.9, though Heather points out Mayo Clinic dietitians look at each patient individually and may aim for a different goal based on each patient’s history, muscle mass and strength, as well as personal goals.

“Definitely we are targeting a BMI less than 35, preferably less than 30,” she says. “I tell people to figure out their calorie needs based on age, weight, gender and activity levels—your dietitian can help you—and to stick with it. You can track your food intake using an app or online program.”

What to Expect from Your Weight Loss

As a rule of thumb, losing 1-2 pounds per week is a realistic expectation, Heather says, pointing out that faster weight loss leads to more muscle mass losses and is likely not sustainable over the long term.

“The key to weight loss is making lifelong lifestyle changes with regard to food and physical activity,” she says. “Diets don’t work, as people do them for a short time and then return to their old patterns.”

It’s also important to keep in mind that each transplant—the organ and the recipient—is different, and that what works for one person’s weight loss might not work for another, Heather explains. She feels strongly, though, that all patients are capable of losing weight after transplant, especially if they make SMART goals and a solid promise to themselves to make changes.

“With commitment to goals, transplant recipients can reach them,” she says.

HELPFUL LINKS

• Explore Mayo’s Transplant Center.
• Read about Mayo Clinic’s Weight-Loss Plan
• Request an appointment.