Tirzepatide (Zepbound) Improves Kidney Transplant Eligibility in T2D and CKD With Severe Obesity

New data suggest that tirzepatide (Zepbound) improves glycemic control and reduces body mass index (BMI) in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) with severe obesity, thereby improving renal transplant eligibility.

The poster was presented at the Endocrine Society (ENDO) Annual Meeting 2026 by Angel Mary Joseph, MBBS, MD, MRCP, Specialist Trainee Registrar at Leeds Teaching Hospitals NHS Trust. The findings underscore the potential to enhance quality of life and survival, as well as drive the development of new care pathways for this patient population.

Transplant Eligibility Barriers in CKD and T2DM

In patients with T2DM and CKD, a BMI > 35 kg/m² can exclude patients from transplant assessment eligibility, even though renal transplantation is a first-line treatment for diabetic nephropathy, with a survival and cost advantage compared with dialysis. While weight loss is associated with improved cardiovascular outcomes in this population, achieving it can be challenging given comorbid symptoms.

“Ill-sustained weight loss through conventional methods, long waiting times for referrals to weight management services, and patients’ hesitation toward bariatric surgery are common obstacles to achieving the target BMI required for renal transplant assessment,” Joseph and colleagues wrote.

Study Design and Tirzepatide Use

To assess the role of tirzepatide in improving BMI and glycemic control to facilitate transplant assessment eligibility, Joseph and colleagues initiated treatment with tirzepatide and monitored BMI and glycated hemoglobin over an average of 10 months.

The patient cohort included individuals with T2DM and suboptimal glycemic control, advanced CKD (either on dialysis or with an estimated glomerular filtration rate [eGFR] <18 mL/min/1.73 m²) and BMI >35 kg/m², who were ineligible for transplant assessment due to elevated BMI, meeting national criteria for tirzepatide use.

Glycemic and Weight Outcomes

The baseline mean weight was 112.7 kg, with a BMI of 41.2 kg/m² and HbA1c of 61.9 mmol/mol (7.8%). At follow-up, mean weight decreased to 102.6 kg, BMI to 37.5 kg/m², and HbA1c to 52 mmol/mol (6.9%).

Transplant Eligibility Gains

In total, 8 patients reached a BMI <35 kg/m², allowing eligibility for transplant assessment. In this subgroup, mean weight decreased from 107.4 kg to 96.4 kg, BMI from 38.3 kg/m² to 34.1 kg/m², and HbA1c from 62.9 mmol/mol (7.9%) to 52.8 mmol/mol (7.0%). Tirzepatide was well tolerated, with no reported severe hypoglycemia.

References

1. Joseph A, Mansfield M, Gullapudi V. Improving Renal Transplant Eligibility with Tirzepatide in Patients with Type 2 Diabetes, Obesity and Advanced Chronic Kidney Disease. Poster presented at: ENDO Annual Conference; June 13, 2026; Chicago, IL.

2. Fourtounas C. Transplant options for patients with type 2 diabetes and chronic kidney disease. World Journal of Transplantation. 2014;4(2):102. doi:https://doi.org/10.5500/wjt.v4.i2.102