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Obesity Surgery

, Volume 29, Issue 8, pp 2373–2380 | Cite as

Bariatric Surgery Is Efficacious and Improves Access to Transplantation for Morbidly Obese Renal Transplant Candidates

  • Renana YeminiEmail author
  • Eviatar Nesher
  • Idan Carmeli
  • Janos Winkler
  • Ruth Rahamimov
  • Eytan Mor
  • Andrei Keidar
Original Contributions

Abstract

Background

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.

Methods

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).

Results

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.

Conclusions

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.

Keywords

End-stage renal disease Chronic renal disease Dialysis Morbid obesity Bariatric surgery LSG LRYGB 

Abbreviations

BMI

Body mass index

ESRD

End-stage renal disease

%EWL

Percent excess weight loss

LAGB

Laparoscopic adjustable gastric banding

LRYGB

Laparoscopic Roux-en-Y gastric bypass

LSG

Laparoscopic sleeve gastrectomy

T2DM

Type 2 diabetes mellitus

%TWL

Percent total weight loss

Notes

Author Contribution

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.

Informed Consent

For this type of study, formal consent is not required.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of SurgeryAssuta Ashdod Medical CenterAshdodIsrael
  2. 2.Ben-Gurion UniversityBeer-ShevaIsrael
  3. 3.Departments of Transplant SurgeryBeilinson Medical CenterPetach-TikvaIsrael
  4. 4.Sackler Faculty of MedicineTel-Aviv UniversityTel-AvivIsrael
  5. 5.Departments of NephrologyBeilinson Medical CenterPetach-TikvaIsrael
  6. 6.Bariatric Clinic, Department of SurgeryBeilinson Medical CenterPetach-TikvaIsrael

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