Weight Loss After Bariatric Surgery in Morbidly Obese End-Stage Kidney Disease Patients as Preparation for Kidney Transplantation. Matched Pair Analysis in a High-Volume Bariatric and Transplant Center

Abstract

Background The number of morbidly obese kidney transplant candidates is growing. They have limited access to kidney transplantation and are at a higher risk of postoperative complications. Bariatric surgery is considered as a safe weight loss method in those patients. Objectives Matched pair analysis was designed to analyze the preparatory and postoperative weight loss after bariatric procedures in end-stage kidney disease (ESKD) and non-ESKD morbidly obese patients. Methods Twenty patients with ESKD underwent bariatric surgery in our Centre of Excellence for Bariatric and Metabolic Surgery between 2015 and 2019 (nine one-anastomosis gastric bypasses, nine Roux-en-Y gastric bypasses, and two sleeve gastrectomies). They were compared with matched pairs from a dataset of 1199 morbidly obese patients without ESKD. Data on demographic factors and comorbidities was recorded. BMI was obtained at the start of the preparatory period preceding the bariatric procedure, at the time of procedure, and during the 1-year follow-up. Results The ESKD and non-ESKD patients did not differ significantly in preoperative weight loss (13.00 ± 11.69 kg and 15.22 ± 15.96 kg respectively, p = 0.619). During the 1-year follow-up, the weight loss was similar to the non-ESKD group. In the first 3 months, faster weight loss in ESKD was observed. Initial and follow-up BMI values did not differ significantly between groups. We demonstrated that obese patients with ESKD can lose weight as effectively as non-ESKD patients. Conclusion Morbidly obese ESKD patients have an equal weight loss to patients without ESKD. Bariatric surgery could improve access to kidney transplantation and may potentially improve transplantation outcomes of obese patients with ESKD.

Obesity in work-up of kidney transplant candidates – review of clinical practice guidelines.

“…SG in ESKD patients is not related to higher risk of leaks, reoperations, or mortality in 1 year follow-up [59]. Our center morbidly obese ESKD patients have similar weight loss results after bariatric procedure than non-ESKD [42,44]. Nine of twenty of them underwent kidney transplantation without any perioperative complications and with good kidney function in follow-up.…”

“…Two bariatric procedures were preferred [23,40]. LSG (laparoscopic sleeve gastrectomy) and LRYGB (laparoscopic roux-en-y gastric bypass) appear to cause effective weight-loss before KT and improve surgical access during transplantation [41][42]. Uncertainties exist regarding optimal timing of bariatric surgery [38].…”

Preoperative Cardiovascular Assessment of the Renal Transplant Recipient: A Narrative Review

“…There is also much interest in the possibility of bariatric surgery in either potential renal transplant candidates or post-renal transplant [ 131 , 132 , 133 , 134 , 135 , 136 , 137 , 138 , 139 ]. Several studies have shown that bariatric surgery is safe and feasible in patients with ESKD and kidney transplant recipients [ 133 , 138 ].…”

Intensive management of obesity in people with severe chronic kidney disease: A review

“…Outcomes following sleeve gastrectomy (SG) were reported in 20 studies, 20,21,23,24,26,[28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] gastric bypass (GB) in 17 studies, [19][20][21][22][23][24][25][27][28][29][30]33,[35][36][37]41,42 adjustable gastric banding (AGB) in 10 studies, [20][21][22][23][27][28][29][30]33,41 and duodenal switch in two studies. 22,41 Fifteen studies reported on multiple bariatric surgery techniques.…”

“…22,41 Fifteen studies reported on multiple bariatric surgery techniques. [20][21][22][23][24][27][28][29][30]33,[35][36][37]41,42 Overall complication rates were low, although there was variability among studies (Table 5). Complication rates in people with ESKD did not differ from the control population in three studies, 21,23,40 but…”