Gastric Bypass in Morbidly Obese Patients With Chronic Renal Failure and Kidney Transplant

Alexander, J. Wesley; Goodman, Hope R.; Gersin, Keith S.; Cardi, M.; Austin, J; Goel, Sharad; Safdar, S.; Huang, Shuo; Woodle, E. Steve

doi:10.1097/00007890-200407271-00867

Cited by 37 publications

(48 citation statements)

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“…74 With mortality and complication rates of bariatric surgery on patients with renal failure at a minimal 0.27%, we strongly recommend potential obese renal transplant candidates to consider bariatric surgery as a way to improve posttransplant outcomes and quality of life. [75][76][77] In conclusion, our results have clearly demonstrated the greater risks in obese renal transplant recipients and the poorer outcomes posttransplant versus healthy patients. Obese recipients showed a greater risk of having BPAR, death, allograft loss, and DGF compared with their healthy BMI counterparts.…”

Section: Discussionsupporting

confidence: 56%

Untitled

2016

Exp Clin Transplant

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Objectives: The prevalence of obesity is increasing rapidly and globally, yet systemic reviews on this topic are scarce. Our meta-analysis and systemic review aimed to assess how obesity affects 5 postoperative outcomes: biopsy-proven acute rejection, patient death, allograft loss, type 2 diabetes mellitus after transplant, and delayed graft function. Materials and Methods: We evaluated peer-reviewed literature from 22 medical databases. Studies were included if they were conducted in accordance with the Meta-analysis of Observational Studies in Epidemiology criteria, only examined postoperative outcomes in adult patients, only examined the relation between recipient obesity at time of transplant and our 5 postoperative outcomes, and had a minimum score of > 5 stars on the Newcastle-Ottawa scale for nonrandomized studies. Reliable conclusions were ensured by having our studies examined against 2 internationally known scoring systems. Obesity was defined in accordance with the World Health Organization as having a body mass index of > 30 kg/m 2 . All obese recipients were compared versus "healthy" recipients (body mass index of 18.5-24.9 kg/m 2 ). Hazard ratios were calculated for biopsy-proven acute rejection, patient death, allograft loss, and type 2 diabetes mellitus after transplant. An odds ratio was calculated for delayed graft function. Results: We assessed 21 retrospective observational studies in our meta-analysis (N = 241 381 patients). In obese transplant recipients, hazard ratios were 1.51 (95% confidence interval, 1.24-1.78) for presence of biopsy-proven acute rejection, 1.19 (95% confidence interval, 1.10-1.31) for patient death, 1.54 (95% confidence interval, 1.38-1.68) for allograft loss, and 1.01 (95% confidence interval, 0.98-1.07) for development of type 2 diabetes mellitus. The odds ratio for delayed graft function was 1.81 (95% confidence interval, 1.51-2.13). Conclusions: Our meta-analysis clearly demonstrated greater risks for obese renal transplant recipients and poorer postoperative outcomes with obesity. We confidently recommend renal transplant candidates seek medically supervised weight loss before transplant.

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Section: Discussionsupporting

confidence: 56%

Untitled

2016

Exp Clin Transplant

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“…In addition, the weight loss experienced is generally more gradual, since it is only a restrictive procedure and not a mal-absorptive procedure, thus avoiding the rapid weight loss that may be a risk for liver injury. The benefits of combined surgery are that it involves a single operation and recovery for the patient, and thus avoids a potentially more hostile re-operative field, as well as avoiding other barriers to weight loss surgery such as delays due to complications like rejection, infection or disease recurrence [178][179][180][181]. The disadvantage is the potential for increased complications.…”

Section: Obesity Treatmentmentioning

confidence: 99%

Prevalence of Metabolic Syndrome in Organ Transplantation: A Review of the Literature

Pinna¹,

Pagotto²

2015

Endocrinol Metab Syndr

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The clinical features of the Metabolic Syndrome (MS) as risk factors for transplantation have been cited separately and extensively in the transplant literature. There are few studies in literature evaluating the prevalence of MS before and after solid organ transplantation.MS puts transplant patients at risk in in two ways: 1) MS is one more risk factor to be considered in the pretransplantation workup; and 2) the combined risk of cardiovascular disease post-transplantation as a side effect of immunosuppressive medication together with the risk from cardiovascular disease stemming from the MS might put a post-transplantation patient at vastly increased risk for a cardiovascular event.There are several reports on the treatment of MS expecially after transplantation; from lifestyle changes to drug therapies. However, to now, guidelines about management of these patients are lacking.

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“…Absorption and metabolism of immunosuppressive medications may be altered after gastric bypass. Cyclosporine, tacrolimus, sirolimus and mycophenolic acid levels have been noted to be altered in gastric bypass patients and requires specific levels for those medications to be followed up (43). Gastric bypass also increases risk for hyperoxaluria and oxalate nephropathy, and when undergoing gastric bypass patients should be advised against risks for oxalate nephrolithiasis and secondary CKD (38).…”

Section: Obesitymentioning

confidence: 99%