Kidney Transplantation and Gastric Bypass: A Better Control of Comorbidities

Abstract

The database of patients who underwent laparoscopic gastric bypass at our institution from 2002 to 2008 was reviewed. Five patients with kidney transplants were found. The impact of the laparoscopic gastric bypass on their comorbidities and the grafts and patients' survival were studied. The five patients of the group are between 36 and 66 years old, three men and two women. Preoperative body mass index ranged between 35 and 42 kg/m(2). The first patient was operated on 4 years ago and presented an anastomotic leak at the gastrojejunal anastomosis that healed with medical treatment. The remaining four patients did not present postoperative complications. At the moment of analysis, the five patients were healthy and enjoying a good quality of life. All the patients had dyslipidemia which reached normal levels after surgery. Three of the patients had diabetes and achieved good control after the surgery. Most importantly, the absorption of immune suppressors was not altered; while some of the patients were even able to reduce their doses. Patients with renal terminal renal diseases and those with renal transplants with severe or morbid obesity are a group that can particularly benefit from a gastric bypass. The laparoscopic gastric bypass is feasible in severely or morbidly obese patients with kidney transplantation. The absorption of the immune-suppressive medication is not altered after a gastric bypass.

Bariatric Surgery and Kidney-Related Outcomes

“…Because the vast majority of surgeries are now laparoscopic LSG, further research is needed to examine outcomes of transplantation candidates and patients using these methods. Whether the pharmacokinetics of immunosuppressive drugs is altered in the setting of bariatric surgery is another open question and requires further study to draw firm conclusions 69, 70, 71, 72, 73…”

Where to Begin and Where to End? Preoperative Assessment for Patients Undergoing Metabolic Surgery

“…As T2DM and obesity are important causes of graft failure and posttransplant complications, metabolic surgery in patients prior to or after renal or combined pancreas-kidney transplantation could become an important topic in the future. There are case reports of metabolic surgery after renal transplantations [56,57], as well as case reports of bariatric surgery as a bridge for kidney transplantation in obese patients [58]. The available literature consists of case reports and small case series allowing only vague and general assumptions: both sleeve gastrectomy and RYGB seem to be feasible in patients prior to or after organ transplantation.…”

Roux‐en‐Y gastric bypass is an effective bridge to kidney transplantation: Results from a single center

“…Bariatric surgery (BS) has been shown to be an effective alternative for achieving weight loss and is associated with decreased mortality . With respect to morbidly obese patients with ESRD, BS has become increasingly utilized with the goals of improving access to and potentially reducing complications following kidney transplantation . Roux‐en‐Y gastric bypass (RYGB), among the most popular BS procedures, results in dramatic weight loss .…”