Laparoscopic bariatric surgery improves candidacy in morbidly obese patients awaiting transplantation

Takata, Mark; Campos, Guilherme M.; Ciovica, Ruxandra; Rabl, Charlotte; Rogers, Stanley J.; Cello, John P.; Ascher, Nancy L.; Posselt, Andrew M.

doi:10.1016/j.soard.2007.12.009

Cited by 182 publications

(122 citation statements)

References 28 publications

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“…In summary, the incidence of allograft oxalate nephropathy is likely to rise, given trends in obesity and bariatric surgery among transplant recipients and those on the waitlist (6,17,18). A high index of suspicion is warranted in bariatric surgery patients with unexplained allograft dysfunction.…”

Section: Discussionmentioning

confidence: 99%

“…Morbidly obese patients are increasingly encouraged to consider bariatric surgery in order to meet body mass index thresholds for renal or other solid-organ transplantation. Some recipients have a more remote history of bariatric surgery, and others may undergo surgery after transplantation (6,17,18). Registry data report that the prevalence of obesity among kidney transplant recipients increased from 23% to 33% over the last decade (18).…”

Section: Introductionmentioning

confidence: 99%

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Enteric Oxalate Nephropathy in the Renal Allograft: An Underrecognized Complication of Bariatric Surgery

Troxell

Houghton

Hawkey³

et al. 2013

American Journal of Transplantation

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Enteric hyperoxalosis is a recognized complication of bariatric surgery, with consequent oxalate nephropathy leading to chronic kidney disease and occasionally end-stage renal failure. In patients with prior gastrointestinal bypass surgery, renal allografts are also at risk of oxalate nephropathy. Further, transplant recipients may be exposed to additional causes of hyperoxalosis. We report two cases of renal allograft oxalate nephropathy in patients with remote histories of bariatric surgery. Conservative management led to improvement of graft function in one patient, while the other patient returned to dialysis. Interpretation of serologic, urine and biopsy studies is complicated by oxalate accumulation in chronic renal failure, and heightened excretion in the early posttransplant period. A high index of suspicion and careful clinicopathologic correlation on the part of transplant nephrologists and renal pathologists are required to recognize and treat allograft oxalate nephropathy. As the incidence of obesity and pretransplant bariatric surgery increases in the transplant population, allograft oxalate nephropathy is likely to be an increasing cause of allograft dysfunction.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Enteric Oxalate Nephropathy in the Renal Allograft: An Underrecognized Complication of Bariatric Surgery

Troxell

Houghton

Hawkey³

et al. 2013

American Journal of Transplantation

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“…Takata et al 13 assessed 15 patients with severe liver disease (six of which were cirrhotic patients) treated with vertical sleeve gastrectomy and noted a 33% loss of excess weight after one year, with perioperative complications in two (13.3%) patients, both of whom were cirrhotic. In 26 transplant candidates submitted to vertical sleeve gastrectomy assessed by Lin et al, 14 perioperative complications were noted in 23.1%, with no mortality.…”

Section: Resultsmentioning

confidence: 99%

Bariatric surgery in individuals with liver cirrhosis: A narrative review

Cazzo

Gestic

Chaim

et al. 2017

Rev. Assoc. Med. Bras.

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Summary Introduction: Bariatric surgery has become the gold standard treatment for morbid obesity, but there is no consensus regarding its safety and efficacy among individuals with chronic liver diseases. Objective: To critically evaluate the existing evidence on literature about bariatric surgery in individuals with liver cirrhosis. Method: Narrative review performed by means of an online search in the MEDLINE and LILACS databases. Results: Bariatric surgery is safe and effective in individuals with chronic liver disease without clinical decompensation or significant portal hypertension. Individuals with severe liver function impairment present significantly higher surgical morbidity and mortality. Among candidates to liver transplantation, surgery may be performed before, after and even during transplantation, and there is a predominant trend to perform it after. Vertical sleeve gastrectomy seems to be the most adequate technique in this group of subjects. Conclusion: Bariatric surgery is safe and effective in individuals with compensated cirrhosis without significant portal hypertension, but presents higher morbidity. Among candidates to liver transplantation and/or individuals with severe portal hypertension, morbidity and mortality are significantly higher.

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“…We recommend that obese renal transplant candidates not be excluded because of their BMI alone, as the survival rate of obese patients after renal transplant is far greater than that shown in obese patients on dialysis treatment. 78,70 Where obese renal transplant candidates should be placed on the organ wait list is a highly controversial issue yet to be resolved. Second, we recommend that obese renal transplant candidates with a BMI > 35 kg/m 2 and with comorbidities or candidates with a BMI > 40 kg/m 2 to be carefully assessed for bariatric surgery before transplant.…”

Section: Discussionmentioning

confidence: 99%

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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Laparoscopic bariatric surgery improves candidacy in morbidly obese patients awaiting transplantation

Cited by 182 publications

References 28 publications

Enteric Oxalate Nephropathy in the Renal Allograft: An Underrecognized Complication of Bariatric Surgery

Enteric Oxalate Nephropathy in the Renal Allograft: An Underrecognized Complication of Bariatric Surgery

Bariatric surgery in individuals with liver cirrhosis: A narrative review

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