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Sleeve gastrectomy surgery in obese patients post–organ transplantation

Published:December 02, 2015DOI:https://doi.org/10.1016/j.soard.2015.11.030

      Abstract

      Background

      Among organ transplant recipients, a common side effect of immunosuppressive therapy is the development of obesity, which affects a third of the patients within 3 years after transplantation. Bariatric surgery represents a possible surgical option for weight loss among posttransplant patients.

      Objectives

      The aim of this study was to examine percent excess weight loss (%EWL), and percent weight loss (%WL) and perioperative and postoperative complications in posttransplant obese patients after sleeve gastrectomy (SG) compared with nontransplant patients. We hypothesize that transplant patients who undergo SG will not significantly differ in their perioperative or postoperative complications or in their %EWL and %WL compared with nontransplant patients who undergo SG. The second aim was to evaluate the impact of SG on graft function and immunosuppressive therapy in transplant patients.

      Setting

      University hospital.

      Methods

      Among 500 consecutive patients who underwent SG from January 2008 to June 2014, 10 patients were organ transplant recipients. The following variables were compared between groups: patient demographic characteristics and co-morbidities, type of transplant surgery, date of transplant surgery, pretransplant body mass index (BMI), date of bariatric surgery, prebariatric surgery BMI, operative time, length of hospitalization, postoperative complications, and change in BMI, %EWL, and %WL. Data were also collected on renal, liver, and pancreas graft function parameters and changes in immunosuppressive medications.

      Results

      Six patients had a kidney transplant, 2 patients had a liver transplant, and 2 had a pancreas transplant. No significant differences were observed in %EWL or %WL at 6 and 12 months follow-up between transplant and nontransplant patients. No transplant patients were lost to follow-up at 6 and 12 months. Among nontransplant patients, 36.7% and 35.7% were lost to follow-up at 6 and 12 months, respectively. No postoperative complications were registered in the transplant group. SG did not negatively affect the graft function.

      Conclusion

      Initials results found that there were no significant differences in %EWL or %WL at 6 and 12 months follow-up between transplant and nontransplant patients. There were also no perioperative and postoperative complications among transplant patients after SG.

      Keywords

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      References

        • Hasse J.
        Pretransplant obesity: a weighty issue affecting transplant candidacy and outcomes.
        Nutr Clin Pract. 2007; 22: 494-504
        • Laish I.
        • Braun M.
        • Mor E.
        • Sulkes J.
        • Harif Y.
        • Ben Ari Z.
        Metabolic syndrome in liver transplant recipients: prevalence, risk factors, and association with cardiovascular events.
        Liver Transpl. 2011; 17: 15-22
        • Weiss H.
        • Nehoda H.
        • Labeck B.
        • Oberwalder M.
        • Konigsrainer A.
        • Margreiter R.
        Organ transplantation and obesity: evaluation, risks and benefits of therapeutic strategies.
        Obes Surg. 2000; 10: 465-469
        • Kokot F.
        • Adamczak M.
        • Wiecek A.
        • Spiechowicz U.
        • Mesjasz J.
        Plasma immunoreactive leptin and neuropeptide Y levels in kidney transplant patients.
        Am J Nephrol. 1999; 19: 28-33
        • Kokot F.
        • Wiecek A.
        • Adamczak M.
        • et al.
        Pathophysiological role of leptin in patients with chronic renal failure, in kidney transplant patients, in patients with essential hypertension, and in pregnant women with preeclampsia.
        Artific Organs. 1999; 23: 70-74
        • Baskin D.G.
        • Hahn T.M.
        • Schwartz M.W.
        Leptin sensitive neurons in the hypothalamus.
        Horm Metab Res. 1999; 31: 345-350
        • Pischon T.
        • Sharma A.M.
        Obesity as a risk factor in renal transplant patients.
        Nephrol Dial Transplant. 2001; 16: 14-17
        • Pirsch J.D.
        • Armbrust M.J.
        • Knechtle S.J.
        • et al.
        Obesity as a risk factor following renal transplantation.
        Transplantation. 1995; 59: 631-633
        • Hakeem A.R.
        • Cockbain A.J.
        • Raza S.S.
        • et al.
        Increased morbidity in overweight and obese liver transplant recipients: a single-center experience of 1325 patients from the United Kingdom.
        Liver Transpl. 2013; 19: 551-562
        • Gloy V.L.
        • Briel M.
        • Bhatt D.L.
        • et al.
        Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials.
        BMJ. 2013; 347: f5934
        • Duchini A.
        • Brunson M.E.
        Roux-en-Y gastric bypass for recurrent nonalcoholic steatohepatitis in liver transplant recipients with morbid obesity.
        Transplantation. 2001; 72: 156-159
        • Alexander J.W.
        • Goodman H.R.
        • Gersin K.
        • et al.
        Gastric bypass in morbidly obese patients with chronic renal failure and kidney transplant.
        Transplantation. 2004; 78: 469-474
        • Al-Nowaylati A.R.
        • Al-Haddad B.J.
        • Dorman R.B.
        • et al.
        Gastric bypass after liver transplantation.
        Liver Transpl. 2013; 19: 1324-1329
        • Lin M.Y.
        • Tavakol M.M.
        • Sarin A.
        • et al.
        Safety and feasibility of sleeve gastrectomy in morbidly obese patients following liver transplantation.
        Surg Endosc. 2013; 27: 81-85
        • Tichansky D.S.
        • Madan A.K.
        Laparoscopic Roux-en-Y gastric bypass is safe and feasible after orthotopic liver transplantation.
        Obes Surg. 2005; 15: 1481-1486
        • Elli E.
        • Gonzalez-Heredia R.
        • Sarvepalli S.
        • Masrur M.
        Laparoscopic and robotic sleeve gastrectomy: short- and long-rerm results.
        Obes Surg. 2015; 25: 967-974
        • Jackson T.D.
        • Hutter M.M.
        Morbidity and effectiveness of laparoscopic sleeve gastrectomy, adjustable gastric band, and gastric bypass for morbid obesity.
        Adv Surg. 2012; 46: 255-268
        • Buch K.E.
        • El-Sabrout R.
        • Butt K.M.
        Complications of laparoscopic gastric banding in renal transplant recipients: a case study.
        Transplant Proc. 2006; 38: 3109-3111
        • Heimbach J.K.
        • Watt K.D.
        • Poterucha J.J.
        • et al.
        Combined liver transplantation and gastric sleeve resection for patients with medically complicated obesity and end-stage liver disease.
        Am J Transplant. 2013; 13: 363-368
        • Elli E.F.
        • Masrur M.A.
        • Giulianotti P.C.
        Robotic sleeve gastrectomy after liver transplantation.
        Surg Obes Relat Dis. 2013; 9: e20-e22
        • Miller A.D.
        • Smith K.M.
        Medication and nutrient administration considerations after bariatric surgery.
        Am J Health Syst Pharm. 2006; 63: 1852-1857
        • Jackson TD
        • Zhang R
        • Glockler D
        • et al.
        Health inequity in access to bariatric surgery: a protocol for systematic review.
        Syst Rev. 2014; 3: 15
        • Hamad G.G.
        • Helsel J.C.
        • Perel J.M.
        • et al.
        The effect of gastric bypass on the pharmacokinetics of serotonin reuptake inhibitors.
        Am J Psychiatry. 2012; 169: 256-263
        • Rogers C.C.
        • Alloway R.R.
        • Alexander J.W.
        • Cardi M.
        • Trofe J.
        • Vinks A.A.
        Pharmacokinetics of mycophenolic acid, tacrolimus and sirolimus after gastric bypass surgery in end-stage renal disease and transplant patients: a pilot study.
        Clin Transplant. 2008; 22: 281-291
        • Szomstein S.
        • Rojas R.
        • Rosenthal R.J.
        Outcomes of laparoscopic bariatric surgery after renal transplant.
        Obes Surg. 2010; 20: 383-385
        • Zelones J.
        • Biswas O.
        • Mehran A.
        Laparoscopic sleeve gastrectomy after simultaneous pancreas-kidney transplant.
        Am Surg. 2012; 78: 613-614
        • Bonatti H.
        • Schmitt T.
        • Northup J.
        • et al.
        Laparoscopic gastric banding in a kidney-pancreas transplant recipient with new onset type II diabetes mellitus associated with morbid obesity.
        Clin Transplant. 2008; 22: 829-832