Bariatric Surgery Is Efficacious and Improves Access to Transplantation for Morbidly Obese Renal Transplant Candidates
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The surgical risk of morbidly obese patients is high and even higher for kidney transplant candidates. A BMI > 35–40 kg/m2 is often a contraindication for that surgery. The safety, feasibility, and outcome of bariatric surgery for those patients are inconclusive.
We conducted a retrospective chart review of prospectively collected data on morbidly obese renal transplant candidates who underwent laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB) in our institution between January 2009 and September 2017. The reported outcome included body weight and graft status after a mean follow-up of 47 months (range 0.5–5 years).
Twenty-four patients (8 females, 16 males, average age 54 years, average preoperative BMI 41 kg/m2 [range 35–51]) underwent LSG (n = 17) or LRYGB (n = 7). Sixteen of them (67%) proceeded to kidney transplantation. Of the 8 pre-transplant and post-bariatric surgery patients, 5 are on the waitlist, and 2 patients died (one of staple line leakage, and one from sepsis unrelated to the bariatric surgery). The average time from bariatric surgery to transplantation was 1.5 years (range 1 month to 4.3 years). The average pre-transplantation BMI was 28 kg/m2 (range 19–36). The mean percentage of excess weight loss was 66% (n = 21), and the total percentage of weight loss was 29% (n = 21). Comorbidities (type 2 diabetes, hypertension, and dyslipidemia) improved significantly following both surgical approaches.
LSG and LRYGB appear to effectively address obesity issues before kidney transplantation and improve surgical access. Morbidly obese transplant candidates would benefit from prior bariatric surgery.
KeywordsEnd-stage renal disease Chronic renal disease Dialysis Morbid obesity Bariatric surgery LSG LRYGB
Body mass index
End-stage renal disease
Percent excess weight loss
Laparoscopic adjustable gastric banding
Laparoscopic Roux-en-Y gastric bypass
Laparoscopic sleeve gastrectomy
Type 2 diabetes mellitus
Percent total weight loss
Renana Yemini participated in the research design, data analysis, writing of the paper and performance of the research.
Eviatar Nesher participated in the performance of the research.
Idan Carmeli participated in the research design and interpretation of data for the work.
Janos Winkler participated in writing of the paper.
Ruth Rahamimov participated in interpretation of data for the work.
Eytan Mor participated in writing of the paper, data analysis, and interpretation of data for the work.
Andrei Keidar participated in the research design, writing of the paper, and interpretation of data for the work.
Compliance with Ethical Standards
The institutional review board approved the prospective data collection.
Conflict of Interest
The authors declare that they have no conflicts of interest.
For this type of study, formal consent is not required.
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