Medication-assisted weight loss leads to lifesaving kidney transplant

Before Belinda Gray could be placed on the organ transplant waiting list, she had to face a major hurdle: lowering her body mass index (BMI) to qualify for a kidney transplant.

“I had started losing weight on my own, but it was really difficult,” said the Chicagoland native, 59. “I needed more help.”

This year, Gray became the first patient to qualify for and undergo a transplant through the University of Chicago Medicine’s groundbreaking ACTNOW transplant weight-loss program.

The Access to Transplant Through Novel Approaches initiative — ACTNOW for short — helps patients lose weight with coaching and personalized, medication-assisted treatment plans so they are eligible for transplant surgery and enhanced outcomes. Among the transplant-trained care team members: advanced practice provider Courtney Kelley, DNP, APN; transplant pharmacists Anesia Reticker, PharmD, and Jenna Boznos, PharmD; and dietitian Annie Guinane, MS, RD.

ACTNOW cofounder Reticker has worked with the nationally acclaimed program since the clinic opened in 2023.

“The clinic started because we wanted to help people who are underserved and underrepresented due to their weight," Reticker said. "We wondered, ‘How can we use novel weight-loss medications to get patients to the wait list and beyond?’”

ACTNOW participants are prescribed GLP-1 agonist medications, short for glucagon-like peptide-1. These agents work by mimicking the action of the body’s naturally occurring hormone GLP-1, produced in the intestines in response to food intake. GLP-1 weight-loss medications offered are known by many names, such as semaglutide, tirzepatide, liraglutide and Ozempic, Wegovy, Mounjaro and Zepbound.

“These are life-changing and lifesaving medications,” Reticker said. “They help improve blood sugar control, delay stomach emptying, allow people to feel full faster and for longer periods of time, and they help silence cravings and ‘food noise.’”

Transplant surgeon Ashley Suah, MD, who specializes in kidney and liver transplants, emphasizes the importance of meeting the BMI criteria. Before she performed Gray's transplant, she noted, her patient needed to reach a BMI of less than 35 to have a successful outcome.

“From a technical standpoint, operations are more difficult when a patient is obese, and our primary goal as surgeons is to keep our patients safe," Suah said. "The higher amount of body fat associated with obesity can make accessing certain blood vessels more challenging. Additionally, obese patients can be at risk for more complications, and recovery time can be longer."

Having access to the ACTNOW clinic is revolutionary for patients whose weight can prevent them from receiving a transplant.

“This program is incredible," Suah said. "Reliable access to these specialists and medications is instrumental. We are blessed to have an expert care team committed to patient needs to help them succeed."

In addition to the weekly GLP-1 injections taken at home, patients in the ACTNOW program follow a tailored nutrition plan designed to meet their individual needs. They work closely with program experts to ensure success.

Dietitian and ACTNOW cofounder Guinane assists patients with dietary and lifestyle changes to support their weight-loss goals.

“We meet the patient where they’re at,” Guinane said. “It doesn’t happen overnight, but with small changes, over time and continuing post-transplant, we have seen great success.”

Because the GLP-1 medication helps effectively curb cravings, patients have an easier time following a meal plan like the Mediterranean diet and staying motivated to reach their goals.

“They love it, and they feel empowered,” Guinane said. “I tell them to consider this medication like a trusty sidekick. If they pair it with movement and dietary changes, they will be successful.”

Gray found the program easy to follow. She met her weight-loss goal in about a year, which qualified her for a kidney transplant in February 2024. She plans to continue taking the GLP-1 medication as part of her post-transplant care to continue to manage her weight.

“I would recommend this program to everyone," Gray said. "I had the support I needed, and the medicine helped me feel full so I could get to my goal easier."