Bariatric surgery to achieve transplant in end-stage organ disease patients: A systematic review and meta-analysis

Orandi, Babak J.; Purvis, Joshua; Cannon, Robert M.; Smith, Anthony; Lewis, Cora E.; Terrault, Norah A.; Locke, Jayme E.

doi:10.1016/j.amjsurg.2020.04.041

Cited by 33 publications

(28 citation statements)

References 66 publications

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“…37,38 Bariatric procedures have been shown to achieve durable weight loss and increase transplant access for appropriate candidates. 39,40 A systematic review/meta-analysis including 288 patients with advanced kidney disease demonstrated that 50% lost sufficient weight for transplant listing. 40 However, access to bariatric surgery remains limited for the population with advanced kidney disease.…”

Section: Recommendationsmentioning

confidence: 99%

See 1 more Smart Citation

A Roadmap for Innovation to Advance Transplant Access and Outcomes: A Position Statement From the National Kidney Foundation

Lentine

Pastan

Mohan

et al. 2021

American Journal of Kidney Diseases

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Over the past 65 years, kidney transplantation has evolved into the optimal treatment for patients with kidney failure, dramatically reducing suffering through improved survival and quality of life. However, access to transplant is still limited by organ supply, opportunities for transplant are inequitably distributed, and lifelong transplant survival remains elusive. To address these persistent needs, the National Kidney Foundation convened an expert panel to define an agenda for future research. The key priorities identified by the panel center on the needs to develop and evaluate strategies to expand living donation, improve waitlist management and transplant readiness, maximize use of available deceased donor organs, and extend allograft longevity. Strategies targeting the critical goal of decreasing organ discard that warrant research investment include educating patients and clinicians about potential benefits of accepting nonstandard organs, use of novel organ assessment technologies and real-time decision support, and approaches to preserve and resuscitate allografts before implantation. The development of personalized strategies to reduce the burden of lifelong immunosuppression and support "one transplant for life" was also identified as a vital priority. The panel noted the specific goal of improving transplant access and graft survival for children with kidney failure. This ambitious agenda will focus research investment to promote greater equity and efficiency in access to transplantation, and help sustain long-term benefits of the gift of life for more patients in need.As this article reflects the official position of the National Kidney Foundation (NKF) and because it was reviewed and approved by NKF, it was not peer reviewed by AJKD. This article was prepared by a work group comprising the authors and chaired by Dr Krista Lentine. It was reviewed and approved by the NKF Scientific Advisory Board and the NKF Executive Committee.Complete author and article information provided before references.

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Section: Recommendationsmentioning

confidence: 99%

“…39,40 A systematic review/meta-analysis including 288 patients with advanced kidney disease demonstrated that 50% lost sufficient weight for transplant listing. 40 However, access to bariatric surgery remains limited for the population with advanced kidney disease.…”

Section: Recommendationsmentioning

confidence: 99%

A Roadmap for Innovation to Advance Transplant Access and Outcomes: A Position Statement From the National Kidney Foundation

Lentine

Pastan

Mohan

et al. 2021

American Journal of Kidney Diseases

View full text Add to dashboard Cite

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“…Obese patients on waiting lists may therefore develop a number of comorbid conditions necessitating temporary wait-list suspension[ 21 ]. On the other hand, in the United States, many insurance payers mandate a trial of medical weight management prior to approving bariatric surgery, but centers that perform bariatric surgery could be reluctant to perform bariatric surgery in these patients due to the potential high rate of complications and death[ 26 ].…”

Section: Obesity and Esrdmentioning

confidence: 99%

“…In obese patients, the risk of parietal dehiscence is significantly increased for BMI > 26 kg/m 2 , while an increased risk of intraoperative blood loss and ureteral stenosis was observed for BMI > 32 kg/m 2 , and the risk of abdominal wall hematoma was increased beyond a BMI of 34 kg/m 2 [ 63 ]. Overall, obese patients have an incidence of wound infections and incisional hernia of 4%-40% due to the longer operative time; the concomitant use of corticosteroids, sirolimus, or everolimus; and the presence of vascular disease[ 26 , 46 , 56 ]. Moreover, obesity may also increase the risk of surgical site infection (SSI), which is a well-known cause of incisional hernia[ 64 , 65 ].…”

Section: Obesity and Kidney Transplantationmentioning

confidence: 99%

Obesity and bariatric surgery in kidney transplantation: A clinical review

Veroux

Mattone

Cavallo

et al. 2021

WJD

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Obesity is increasing worldwide, and this has major implications in the setting of kidney transplantation. Patients with obesity may have limited access to transplantation and increased posttransplant morbidity and mortality. Most transplant centers incorporate interventions aiming to target obesity in kidney transplant candidates, including dietary education and lifestyle modifications. For those failing nutritional restriction and medical therapy, the use of bariatric surgery may increase the transplant candidacy of patients with obesity and end-stage renal disease (ESRD) and may potentially improve the immediate and late outcomes. Bariatric surgery in ESRD patients is associated with weight loss ranging from 29.8% to 72.8% excess weight loss, with reported mortality and morbidity rates of 2% and 7%, respectively. The most commonly performed bariatric surgical procedures in patients with ESRD and in transplant patients are laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass. However, the correct timing of bariatric surgery and the ideal type of surgery have yet to be determined, although pretransplant LSG seems to be associated with an acceptable risk-benefit profile. We review the impact of obesity on kidney transplant candidates and recipients and in potential living kidney donors, exploring the potential impact of bariatric surgery in addressing obesity in these populations, thereby potentially improving posttransplant outcomes.

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“…95,96 Bariatric surgery in transplant patients has been comprehensively reviewed elsewhere. 97,98 Good outcomes have been reported with sleeve gastrectomy pre-and post-liver transplant, [99][100][101][102][103][104][105][106] as well as pre-and post-kidney transplant. 100,102,103 Combined liver transplant and sleeve gastrectomy also demonstrated improvement in weight and metabolic factors posttransplant.…”

Section: Nafld In Kidney Disease Patients and Morbid Obesitymentioning

confidence: 99%

Current and Evolving Indications for Simultaneous Liver Kidney Transplantation

Levitsky

2021

Semin Liver Dis

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This review will discuss the etiologies of kidney disease in liver transplant candidates, provide a historical background of the prior evolution of simultaneous liver–kidney (SLK) transplant indications, discuss the current indications for SLK including Organ Procurement and Transplantation Network policies and Model for End Stage Liver Disease exception points, as well as provide an overview of the safety net kidney transplant policy. Finally, the authors explore unanswered questions and future research needed in SLK transplantation.

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Bariatric surgery to achieve transplant in end-stage organ disease patients: A systematic review and meta-analysis

Cited by 33 publications

References 66 publications

A Roadmap for Innovation to Advance Transplant Access and Outcomes: A Position Statement From the National Kidney Foundation

A Roadmap for Innovation to Advance Transplant Access and Outcomes: A Position Statement From the National Kidney Foundation

Obesity and bariatric surgery in kidney transplantation: A clinical review

Current and Evolving Indications for Simultaneous Liver Kidney Transplantation

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