Kidney transplantation (KTx) is the recommended treatment modality for the end-stage kidney disease (ESKD), because it improves significant patient (pt) survival and improves the quality of life for the dialysis patients. Kidney transplantation in Estonia was started at Tartu University 1968. There have been over 1100 kidney transplantations and today there are over 490 persons with working kidney transplant. KTx is the main renal replacement modality (RRT) forming more than 50% from RRT prevalence patients. However, there are many disagreements and controversies about obesity and body mass index (BMI) for the KTx candidacy criteria.
The aim of the study was to assess the influence of pre-transplant BMI to the graft and patient 5- and 10-years survivals. Our study group consisted of 711 pts who received their KTx after 2000. 52,3% (N=372) of the pts had BMI<25 and 47,7% (N=339) had BMI ≥ 25. 
We found that pts with lower BMI had significantly higher 5-year graft survival (87,1%, N=324) compared with overweight and obese pts (76,4%, N=259). Similarly, 10-year kidney graft survival was better (56,9%, N=212) compared with overweight pts (52,5%, N=178).
KTx recipients 5-year survival was found 87,1% (N=324) in BMI < 25 group and 84,9% (N=288) in BMI≥25 group. 10-year survival was 61,6% (N=229) in BMI < 25 groups and 58,4 (N=198) in BMI≥25 group.
Conclusion: Although the impact of obesity on pt survival after KTx remains controversial, our data revealed that kidney graft and patient’s survival is better in pts with normal BMI. Thus, ESKD pts with overweight and obesity should lose weight prior to KTx.