Laparoscopic sleeve gastrectomy improves renal transplant candidacy and posttransplant outcomes in morbidly obese patients

Abstract

Morbid obesity is a barrier to kidney transplantation due to inferior outcomes, including higher rates of new-onset diabetes after transplantation (NODAT), delayed graft function (DGF), and graft failure. Laparoscopic sleeve gastrectomy (LSG) increases transplant eligibility by reducing BMI in kidney transplant candidates, but the effect of surgical weight loss on posttransplantation outcomes is unknown. Reviewing single-center medical records, we identified all patients who underwent LSG before kidney transplantation from 2011-2016 (n = 20). Post-LSG kidney recipients were compared with similar-BMI recipients who did not undergo LSG, using 2:1 direct matching for patient factors. McNemar's test and signed-rank test were used to compare groups. Among post-LSG patients, mean BMI ± standard deviation (SD) was 41.5 ± 4.4 kg/m at initial encounter, which decreased to 32.3 ± 2.9 kg/m prior to transplantation (P < .01). No complications, readmissions, or mortality occurred following LSG. After transplantation, one patient (5%) experienced DGF, and no patients experienced NODAT. Allograft and patient survival at 1-year posttransplantation was 100%. Compared with non-LSG patients, post-LSG recipients had lower rates of DGF (5% vs 20%) and renal dysfunction-related readmissions (10% vs 27.5%) (P < .05 each). Perioperative complications, allograft survival, and patient survival were similar between groups. These data suggest that morbidly obese patients with end-stage renal disease who undergo LSG to improve transplant candidacy, achieve excellent posttransplantation outcomes.

Bariatric surgery in solid organ transplant patients: Long-term follow-up results of outcome, safety, and effect on immunosuppression

“…These patients pose a multidisciplinary challenge due to multiple comorbidities, use of immunosuppressive agents, risk of graft dysfunction or rejection, and history or current status as patients with insufficiency of 1 or more systems. Due to these limitations, such patients had been considered inoperable, but they are now beginning to enjoy the benefits of BS …”

The obesity paradox: A further consideration in dialysis patients

“…Use of bariatric surgery in morbidly obese transplant candidates was reported to be a safe and effective bridge to KT . Using direct matching for BMI at the time of transplantation, as well as for age, race, and allograft type, obese ESRD patients who underwent laparoscopic sleeve gastrectomy (LSG) and whose pretransplant BMI decreased from 41.5 ± 4.4 to 32.3 ± 2.9 kg/m 2 had similar posttransplant outcomes including perioperative complications, allograft, and patient survival at 1 year compared with non‐LSG recipients …”

“…42 Using direct matching for BMI at the time of transplantation, as well as for age, race, and allograft type, obese ESRD patients who underwent laparoscopic sleeve gastrectomy (LSG) and whose pretransplant BMI decreased from 41.5 ± 4.4 to 32.3 ± 2.9 kg/m 2 had similar posttransplant outcomes including perioperative complications, allograft, and patient survival at 1 year compared with non-LSG recipients. 43 For dialysis patients with sarcopenic obesity, therapeutic intervention to preserve muscle mass and reduce excess body fat is an ultimate goal for improving outcomes. 44 Data from randomized controlled trials have demonstrated that intradialytic resistance exercise training can improve muscle volume and enhance muscle strength and physical performance among HD patients.…”

Obesity as a barrier to kidney transplantation: Time to eliminate the body weight bias?

“…This is the case even when well‐conducted, prospective studies of intentional weight loss on short‐ and long‐term posttransplant outcomes are lacking. Successful transplantation listing after bariatric surgery has been reported in several studies; many of these are small case series, with 55%‐100% of those undergoing bariatric surgery being listed for, or receiving a kidney transplant during follow‐up …”

“…Successful transplantation listing after bariatric surgery has been reported in several studies; many of these are small case series, with 55%-100% of those undergoing bariatric surgery being listed for, or receiving a kidney transplant during followup. [19][20][21][22][23][24] More modest weight loss has been recorded with lifestyle approaches including dietary intervention with or without exercise.…”