Effectiveness and Safety of Bariatric Surgery in Patients with End‐Stage Chronic Kidney Disease or Kidney Transplant

Abstract

ObjectiveThis study aimed to evaluate (1) the effectiveness, complications, and postoperative access to transplantation in end‐stage chronic kidney disease (ECKD) and (2) the effectiveness and complications of bariatric surgery in patients who had already undergone kidney transplant.MethodsA systematic review and meta‐analysis of mortality and complications rates were performed. Thirty studies were reviewed.ResultsAfter bariatric surgery, patients with ECKD had similar postoperative weight loss to patients from the general population. Meta‐analysis showed post–bariatric surgery rates of 2% (95% CI: 0%‐3%) for mortality and 7% (95% CI: 2%‐14%) for complications. Approximately one‐fifth of the patients had access to a transplant. This rate may be underestimated because of the short duration of follow‐up. The lack of control groups did not allow for a conclusion on the role of bariatric surgery in facilitating access to kidney transplantation. In patients who had received a kidney transplant, bariatric surgery seemed to improve renal function but increased graft‐rejection risk, possibly because of changes in the bioavailability of immunosuppressant drugs.ConclusionsBariatric surgery yields significant weight loss in patients with ECKD that improves patients’ chances of accessing a transplant but does not guarantee it; however, the risk for complications and death is higher than in other patients. After transplantation, bariatric surgery‐induced weight loss appeared to positively impact the function of the grafted kidney, but careful monitoring of immunosuppressant medications is required.

Obesity and bariatric surgery in kidney transplantation: A clinical review

“…However, medical management could have limited long-term success, while bariatric surgery could offer a reliable strategy to achieve weight loss in kidney transplant candidates[ 21 , 33 ], with acceptable morbidity and mortality rates[ 34 - 36 ]. Bariatric surgery in ESRD patients is associated with weight loss ranging from 29.8% to 72.8% excess weight loss (%EWL)[ 37 ], with reported mortality and morbidity rates of 2% and 7%, respectively[ 37 ]. Complications associated with bariatric surgery are higher in ESRD patients than in non-ESRD patients[ 37 ]: The mortality rate (2%) observed in the ESRD population is approximately 10 times higher than the mortality rate (0.18%) reported in the general population[ 38 ], while the rate of postoperative complications in ESRD patients is significantly higher than that observed in accredited hospitals for bariatric surgery (0.17%)[ 39 ].…”

“…Bariatric surgery in ESRD patients is associated with weight loss ranging from 29.8% to 72.8% excess weight loss (%EWL)[ 37 ], with reported mortality and morbidity rates of 2% and 7%, respectively[ 37 ]. Complications associated with bariatric surgery are higher in ESRD patients than in non-ESRD patients[ 37 ]: The mortality rate (2%) observed in the ESRD population is approximately 10 times higher than the mortality rate (0.18%) reported in the general population[ 38 ], while the rate of postoperative complications in ESRD patients is significantly higher than that observed in accredited hospitals for bariatric surgery (0.17%)[ 39 ]. However, many studies have consistently shown that bariatric surgery in patients with chronic kidney disease (CKD) stage 1 and 2, is associated with slower epidermal growth factor receptor (eGFR) decline and lower risk of kidney failure[ 40 , 41 ].…”

“…Although there are few studies comparing the two surgical procedures in ESRD patients, RYGB seems to have the potential to improve access to renal transplantation and improve long-term survival compared with LSG[ 35 ]. Both LSG and RYGB achieve significant excess body weight loss (up to 80% within 24 mo) and may increase the likelihood of being listed for kidney transplantation in up to 50.3% of patients, although a recent meta-analysis reported that only 25% of patients had access to transplant at a median follow-up of 48 mo[ 37 ]. A recent analysis of the ESRD population using a probabilistic Markov model concluded that RYGB could improve access to renal transplantation and thereby increase long-term survival[ 42 ], but it could be associated with slightly higher morbidity and mortality rates[ 43 ].…”

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 ].…”

“…Several studies have shown that bariatric surgery is safe and feasible in patients with ESKD and kidney transplant recipients [ 133 , 138 ]. It is also known to be effective and cause a significant reduction in BMI [ 135 ]. This itself in renal transplant candidates may improve outcomes based on the association between high BMI and increased post-operative complications.…”