Highlights
- •Sleeve gastrectomy improves eligibility for kidney transplant in morbidly obese ESRD patients through weight loss
- •Post-sleeve gastrectomy patients undergoing kidney transplantation benefit from excellent post-transplant outcomes
- •New-onset diabetes after transplantation and delayed graft function were lower among post-sleeve gastrectomy patients compared to institutional rates
Abstract
Background
Morbid obesity serves as a barrier to kidney transplantation (KT) due to potential
suboptimal posttransplant outcomes. Laparoscopic sleeve gastrectomy (LSG) has previously
been shown to improve transplant eligibility through weight loss.
Objectives
We aimed to examine the role LSG plays in improving patient outcomes postrenal transplantation,
including possible impact on new-onset diabetes after transplant (NODAT).
Setting
University Hospital.
Methods
A single-center analysis was performed identifying all patients who underwent KT after
LSG from 2011 to 2017 (n = 41). Exclusion criteria included type I diabetes and previous
pancreas transplantation. NODAT was defined as a new insulin requirement after KT.
Delayed graft function was defined as need for dialysis within the first week after
KT. Mean posttransplant follow-up period was 22 months.
Results
Forty-one patients underwent KT after LSG after median time of 16 months. Median age
of postLSG patients undergoing KT was 56.0 years at time of KT. Average body mass
index decreased by 9 from the time of LSG to KT, and no patients regained weight at
1-year follow-up. After LSG, the number of patients with hypertension (85.4% versus
48.5%) and the number of antihypertensive medications used decreased significantly
(1.6 versus .6) at time of KT (P < .001 each). At 1-year follow-up, the improvement in hypertension persisted (51.2%
versus 48.5%, P = nonsignificant). The average insulin regimen decreased from 33.0 ± 51.6 to 11.7
± 21.5 units at KT (P < .001). This improvement also persisted at 1-year follow-up (11.9 versus 11.7 units,
P = nonsignificant). Zero patients suffered NODAT over the follow-up period (versus
institutional rate of NODAT at 15.8%). One patient developed delayed graft function
(2.4%, versus institutional rate of 13.3%). After 1 year postKT, there was 1 graft
loss (2.4%) and no mortality.
Conclusion
This is the largest reported series of KT after planned LSG in morbidly obese patients.
Our results confirm excellent posttransplant outcomes among patients who otherwise
would have been denied KT eligibility.
Key words
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References
- Laparoscopic sleeve gastrectomy improves renal transplant candidacy and posttransplant outcomes in morbidly obese patients.Am J Transplant. 2018; 18: 410-416
- Proceedings from an international consensus meeting on posttransplantation diabetes mellitus: recommendations and future directions.Am J Transplant. 2014; 14: 1992-2000
- New-onset diabetes mellitus after kidney transplantation in Denmark.Clin J Am Soc Nephrol. 2010; 5: 709-716
- The combined effect of pre-transplant triglyceride levels and the type of calcineurin inhibitor in predicting the risk of new onset diabetes after renal transplantation.Nephrol Dial Transplant. 2008; 23: 1436-1441
- Addressing morbid obesity as a barrier to renal transplantation with laparoscopic sleeve gastrectomy.Am J Transplant. 2015; 15: 1360-1368
- A two-year randomized trial of obesity treatment in primary care practice.N Engl J Med. 2011; 365: 1969-1979
- Gastric bypass in morbidly obese patients with chronic renal failure and kidney transplant.Transplantation. 2004; 78: 469-474
- New-onset diabetes after transplantation: results from a double-blind early corticosteroid withdrawal trial.Am J Transplant. 2015; 15: 1982-1990
- Gastrointestinal Surgery for Severe Obesity.NIH Consens Statement Online. 1991 Mar 25-27 [cited 2019 Oct 14]; 9 (Available from: https://consensus.nih.gov/1991/1991gisurgeryobesity084html.htm): 1-20
- Marked variation in the definition and diagnosis of delayed graft function: a systematic review.Nephrol Dial Transplant. 2008; 23: 2995-3003
- Prediction of creatinine clearance from serum creatinine.Nephron. 1976; 16: 31-41
- Addressing the challenges of sleeve gastrectomy in end-stage renal disease: analysis of 100 consecutive renal failure patients.Surgery. 2017; 162: 358-365
- Pretransplantation overweight and obesity: does it really affect kidney transplantation outcomes?.Transplant Proc. 2011; 43: 95-99
- The impact of recipient obesity on outcomes after renal transplantation.Ann Surg. 2013; 257: 978-984
- Association between delayed graft function and allograft and patient survival: a systematic review and meta-analysis.Nephrol Dial Transplant. 2009; 24: 1039-1047
- Analysis of posttransplant diabetes mellitus prevalence in a population of kidney transplant recipients.Transplant Proc. 2008; 40: 1888-1890
- Diabetes mellitus after kidney transplantation in the United States.Am J Transplant. 2003; 3: 178-185
- Laparoscopic sleeve gastrectomy is a novel and effective treatment for obesity in patients with chronic kidney disease.Obes Surg. 2012; 22: 119-123
- Safety analysis of primary bariatric surgery in patients on chronic dialysis.Surg Endosc. 2016; 30: 2583-2591
- Bariatric surgery in patients with dialysis-dependent renal failure.Obes Surg. 2015; 25: 2088-2092
- Laparoscopic sleeve gastrectomy: gateway to kidney transplantation.Surg Obes Relat Dis. 2017; 13: 909-915
Article Info
Publication History
Published online: September 23, 2019
Accepted:
September 13,
2019
Received:
July 31,
2019
Footnotes
Funding was provided by the University of Cincinnati Department of Surgery .
Identification
Copyright
© 2019 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
