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TY DIWAN: The transplant metabolic weight loss program at Mayo Clinic is structured around multidisciplinary care for a very unique population of patients that have complicated obesity.

ALEKSANDRA KUKLA: Many of our patients with obesity also have associated diabetes, hypertension, hyperlipidemia. The goal of this program is to help those patients to get to the transplant as soon as possible with bariatric surgery being the most effective way to do that.

TY DIWAN: We've really taken the team of bariatric surgery, transplant, the bariatrician on the medical side, the dieticians, the physical therapists and pulled them together into one team. We've seen from the data that we have that patients with up to stage three disease, if we can have them lose significant weight with bariatric surgery, their GFR, so their renal function, improves.

ALEKSANDRA KUKLA: With our obesity metabolic program we would like to see even our patients earlier when glomerular filtration rate is 30 or below.

TY DIWAN: What we want to do is take patients that they never thought as a candidate and let us at least evaluate them. If the patient's on dialysis and their BMI is high, that person, no doubt, should be referred. We can identify the patients whose BMI might either be outside criteria for us, which is a BMI above 40, or just in that stage two obesity, 35 to 40, because those are the patients who would qualify for bariatric surgery.

ALEKSANDRA KUKLA: If they schedule bariatric surgery and got through that, usually it takes about two months before they fully recover and many, many patients are able to lose adequate amount of weight by that time.

TY DIWAN: We've also set them up to see the endocrinologist bariatrician. We've also set them up to see the psychologist for bariatrics. They'll see myself. They'll see the dietitian. And so through one visit, whenever that's scheduled, they actually see everybody. And they get education both on the transplant side and the medical and surgical weight loss side.

ALEKSANDRA KUKLA: So when they leave, they have all the tools and understanding what they need to be doing.

TY DIWAN: I think what we do here that no one else can do is that we can take care of these patients in such a way that we can get them from not a candidate to their transplant and do that in a time frame that actually is going to improve their overall survival. And I think that that's really what the important aspect of it is.