Bariatric Surgery to Target Obesity in the Renal Transplant Population: Preliminary Experience in a Single Center

Gazzetta, Paolo; Bissolati, Massimiliano; Saibene, Alessandro; Ghidini, C.; Guarneri, Giovanni; Giannone, Fabio; Adamenko, Olga; Secchi, Antonio; Rosati, Riccardo; Socci, C.

doi:10.1016/j.transproceed.2017.02.032

Cited by 21 publications

(19 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Chen et al reported a case in which VSG at 3 years postkidney transplantation significantly improved body weight and glycaemic control in a patient with post-transplant weight gain and NODAT (183). Several small case series and observational studies have investigated the impact of post-transplant metabolic surgery on body weight, metabolic control, and graft outcomes (184)(185)(186)(187)(188). Viscido (189).…”

Section: Can Metabolic Surgery Assist In the Management Of Post-kidnementioning

confidence: 99%

“…Chen et al reported a case in which VSG at 3 years post-kidney transplantation significantly improved body weight and glycaemic control in a patient with post-transplant weight gain and NODAT ( 183 ). Several small case series and observational studies have investigated the impact of post-transplant metabolic surgery on body weight, metabolic control, and graft outcomes ( 184 – 188 ). Viscido et al demonstrated that VSG at mean 15 years after kidney transplantation reduced mean BMI from 42.2±6.8 to 29.8±7.3 kg/m 2 over 1.4±1-year follow-up in five patients ( 189 ).…”

Section: What Is the Role Of Metabolic Surgery In People With End-stamentioning

confidence: 99%

See 1 more Smart Citation

Metabolic Surgery to Treat Obesity in Diabetic Kidney Disease, Chronic Kidney Disease, and End-Stage Kidney Disease; What Are the Unanswered Questions?

et al. 2020

View full text Add to dashboard Cite

Obesity is a major factor in contemporary clinical practice in nephrology. Obesity accelerates the progression of both diabetic and non-diabetic chronic kidney disease and, in renal transplantation, both recipient and donor obesity increase the risk of allograft complications. Obesity is thus a major driver of renal disease progression and a barrier to deceased and living donor kidney transplantation. Large observational studies have highlighted that metabolic surgery reduces the incidence of albuminuria, slows chronic kidney disease progression, and reduces the incidence of end-stage kidney disease over extended follow-up in people with and without type 2 diabetes. The surgical treatment of obesity and its metabolic sequelae has therefore the potential to improve management of diabetic and non-diabetic chronic kidney disease and aid in the slowing of renal decline toward end-stage kidney disease. In the context of patients with end-stage kidney disease, although complications of metabolic surgery are higher, absolute event rates are low and it remains a safe intervention in this population. Pre-transplant metabolic surgery increases access to kidney transplantation in people with obesity and end-stage kidney disease. Metabolic surgery also improves management of metabolic complications post-kidney transplantation, including new-onset diabetes. Procedure selection may be critical to mitigate the risks of oxalate nephropathy and disruption to immunosuppressant pharmacokinetics. Metabolic surgery may also have a role in the treatment of donor obesity, which could increase the living kidney donor pool with potential downstream impact on kidney paired exchange programmes. The present paper provides a comprehensive coverage of the literature concerning renal outcomes in clinical studies of metabolic surgery and integrates findings from relevant mechanistic pre-clinical studies. In so doing the key unanswered questions for the field are brought to the fore for discussion.

show abstract

Section: Can Metabolic Surgery Assist In the Management Of Post-kidnementioning

confidence: 99%

Section: What Is the Role Of Metabolic Surgery In People With End-stamentioning

confidence: 99%

Metabolic Surgery to Treat Obesity in Diabetic Kidney Disease, Chronic Kidney Disease, and End-Stage Kidney Disease; What Are the Unanswered Questions?

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Allograft function at 1 year was excellent with 100% followup in the transplant cohort, and there was no reported mortality or morbidity [12]. Transplant specific analyses show that bariatric surgery was also safe after renal [17] and liver transplantation [13], with low morbidity and mortality. Our study corroborates these findings with no difference in mortality; however we found that prior solid organ transplantation increases the risk of 30-day morbidity and anastomotic leak in MBS patients.…”

Section: Discussionmentioning

confidence: 87%

“…Studies on post-transplantation bariatric surgery are limited, with varied outcomes [1,[12][13][14]17]. Khoarki et al reported their experience with 10 patients undergoing sleeve gastrectomy after liver, kidney, or heart transplant.…”

Section: Discussionmentioning

confidence: 99%

Bariatric Surgery Outcomes in Patients with Prior Solid Organ Transplantation: an MBSAQIP Analysis

et al. 2020

View full text Add to dashboard Cite

Introduction Obesity is a risk factor for poor patient outcomes after organ transplantation (TXP). While metabolic and bariatric surgery (MBS) is safe and effective in treating severe obesity, the role of MBS in transplant patients continues to evolve. Methods A retrospective analysis was performed of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) patients in the 2017 Metabolic and Bariatric Surgery Accreditation Quality and Improvement Project (MBSAQIP) database. Propensity and case-control matching, and multivariable logistic regression were performed for 30-day post-operative outcomes. Results A total of 336 transplant patients were compared with 157,413 patients without transplant. Propensity and case-control matching reveal no significant differences in mortality (p > 0.2). However, case-control matching revealed longer operative time (104 min versus 76 min, p < 0.001), increased length of stay (2 days versus 1 day, p < 0.05), perioperative transfusions (2% versus 0.22%, p = 0.009), and leak rates (2.2% versus 0.55%, p = 0.02) in the transplant cohort. On multivariable regression analysis, prior transplantation was associated with higher rates of overall (OR 1.6, p = 0.007) and bariatric-related morbidity (OR 1.78, p = 0.004), leak (OR 3.47, p = 0.0027), and surgical site infection (OR 3.32, p = 0.004). Prior transplantation did not predict overall (p = 0.55) nor bariatric-related mortality (p = 0.99). Conclusion MBS in prior solid organ transplantation patients is overall safe, but is associated with increased operative time and length of stay, as well as higher rates of some post-operative morbidity.

show abstract

“…and improved long-term patient and graft survival. [6][7][8][9][10][11][12][13][14][15][16][17] Furthermore, benefits among specific organ transplant subtypes include stabilization or improvement in kidney graft function for kidney transplant recipients and decreased liver graft steatosis and fibrosis for liver transplant recipients with history of nonalcoholic fatty liver disease. [18][19][20][21] However, the perioperative safety of bariatric surgery among patients with history of solid organ transplant is poorly understood, because small studies have poor generalizability and may fail to detect rare events.…”

Section: Introductionmentioning

confidence: 99%

Perioperative risks of bariatric surgery among patients with and without history of solid organ transplant

Montgomery

Cohen

Brown

et al. 2020

American Journal of Transplantation

View full text Add to dashboard Cite

Bariatric surgery is effective among patients with previous transplant in limited case series. However, the perioperative safety of bariatric surgery in this patient population is poorly understood. Therefore, we assessed the safety of bariatric surgery among previous‐transplant patients using a database that captures >92% of all US bariatric procedures. All primary, laparoscopic sleeve gastrectomy and Roux‐en‐Y gastric bypass procedures between 2017 and 2018 were identified from the MBSAQIP dataset. Patients with previous transplant (n = 610) were compared with patients without previous transplant (n = 321 447). Primary outcomes were 30 day readmissions, surgical complications, medical complications, and death. Multivariable logistic regression with predictive margins was used to compare outcomes. Previous transplant patients experienced higher incidence of readmissions (8.0% vs 3.5%), surgical complications (5.0% vs 2.7%), and medical complications (4.3% vs 1.5%). There was no difference in incidence of death (0.2% vs 0.1%). Among individual complications, there no statistical differences in intraabdominal leak, unplanned reoperation, myocardial infarction, or infectious complications. Baseline estimated glomerular filtration rate was found to be a strong moderator of primary outcomes, with the highest risk of complications occurring at the lowest baseline estimated glomerular filtration rate. Given the many long‐term benefits of bariatric surgery among patients with previous transplant, our findings should not preclude this patient population from operative consideration.

show abstract

Bariatric Surgery to Target Obesity in the Renal Transplant Population: Preliminary Experience in a Single Center

Cited by 21 publications

References 26 publications

Metabolic Surgery to Treat Obesity in Diabetic Kidney Disease, Chronic Kidney Disease, and End-Stage Kidney Disease; What Are the Unanswered Questions?

Metabolic Surgery to Treat Obesity in Diabetic Kidney Disease, Chronic Kidney Disease, and End-Stage Kidney Disease; What Are the Unanswered Questions?

Bariatric Surgery Outcomes in Patients with Prior Solid Organ Transplantation: an MBSAQIP Analysis

Perioperative risks of bariatric surgery among patients with and without history of solid organ transplant

Contact Info

Product

Resources

About