Obesity, transplantation, and bariatric surgery: An evolving solution for a growing epidemic

Diwan, Tayyab S.; Lee, Tiffany C.; Nagai, Shunji; Benedetti, Enrico; Posselt, Andrew M.; Bumgardner, Ginny L.; Noria, Sabrena; Whitson, Bryan A.; Ratner, Lloyd E.; Mason, David P.; Friedman, Joëlle Y.; Woodside, Kenneth J.; Heimbach, Julie K.

doi:10.1111/ajt.15784

Cited by 58 publications

(46 citation statements)

References 121 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Therefore, future studies concerning the effects of dietary advice and physical exercise on long-term survival are warranted. Furthermore, in selected patients, bariatric surgery, in particular sleeve gastrectomy, might be feasible and results in weight loss [51,52]. More research, however, is warranted to minimize risk of complications after bariatric surgery in OLT recipients.…”

Section: Discussionmentioning

confidence: 99%

Post-transplant obesity impacts long-term survival after liver transplantation

et al. 2020

View full text Add to dashboard Cite

Background: Short-term survival after orthotopic liver transplantation (OLT) has improved over the past decades, but long-term survival remains impaired. The effects of obesity on long-term survival after OLT are controversial. Because pre-transplant body mass index (BMI) can be confounded by ascites, we hypothesized that posttransplant BMI at 1 year could predict long-term survival. Methods: A post-hoc analysis was performed of an observational cohort study consisting of adult recipients of a first OLT between 1993 and 2010. Baseline BMI was measured at 1-year post-transplantation to represent a stable condition. Recipients were stratified into normal weight (BMI b 25 kg/m 2 ), overweight (25 ≤ BMI ≤ 30 kg/m 2 ), and obese (BMI N 30 kg/m 2 ). Kaplan-Meier survival analyses were performed with log-rank testing, followed by multivariable Cox proportional hazards regression analysis. Results: Out of 370 included recipients, 184 had normal weight, 136 were overweight, and 50 were obese at 1year post-transplantation. After median follow-up for 12.3 years, 107 recipients had died, of whom 46 (25%) had normal weight, 39 (29%) were overweight, and 22 (44%) were obese (log-rank P = 0.020). Obese recipients had a significantly increased mortality risk compared to normal weight recipients (HR 2.00, 95% CI 1.08-3.68, P = 0.027). BMI was inversely associated with 15 years patient survival (HR 1.08, 95% CI 1.03-1.14, P = 0.001 per kg/ m 2 ), independent of age, gender, muscle mass, transplant characteristics, cardiovascular risk factors, kidney-and liver function. Conclusion:Obesity at 1-year post-transplantation conveys a 2-fold increased mortality risk, which may offer potential for interventional strategies (i.e. dietary advice, lifestyle modification, or bariatric surgery) to improve long-term survival after OLT.

show abstract

Section: Discussionmentioning

confidence: 99%

Post-transplant obesity impacts long-term survival after liver transplantation

et al. 2020

View full text Add to dashboard Cite

show abstract

“…It was proven that obesity was associated with a higher risk of delayed graft function, graft loss, and lower patient and graft survival, but interestingly, obese individuals without comorbidities can experience similar survival to nonobese recipients [30][31][32]. However, often due to obesityassociated comorbidities, their access to the transplant list and transplantation is inferior to non-obese [5,33]. Bariatric surgery is considered as a safe method of obesity treatment in that specific group of patients and feasible as a bridge therapy to kidney transplantation [6,[34][35][36].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

View full text Add to dashboard Cite

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.

show abstract

“…This has resulted in a push to perform BS pre‐transplant, particularly in renal failure patients on the kidney wait‐list 20 . A White Paper from the American Society of Transplant Surgeons Obesity in Transplantation Taskforce published in 2020 endorses this approach 21 …”

Section: Discussionmentioning

confidence: 99%

“…While these studies are limited to case reports and case series, overall they demonstrate improved outcomes associated with resultant weight loss at the expense of increased surgical complexity of the latter procedure. A position paper from the American Society of Transplantation states sleeve gastrectomy as the preferred procedure in LTX, and calls for studies investigating simultaneous vs delayed bariatric surgery 21 . However, in the setting of remote history of pre‐transplant RYGB, as may be increasingly common in patients with ESLD listed for LTX given its association with increased risk of alcohol use disorder, 28 expected post transplant outcomes, particularly from an infectious risk standpoint, are relatively unknown.…”

Section: Discussionmentioning

confidence: 99%

Pre‐transplant bariatric surgery is associated with increased fungal infection after liver transplant

Jorgenson

Gracon

Hanlon

et al. 2020

Transplant Infectious Dis

View full text Add to dashboard Cite

Aim The impact of pre‐transplant (pre‐TXP) bariatric surgery (BS) on outcomes after liver transplant (LTX) has not been completely elucidated. Roux‐en Y gastric bypass (RYGB) is one of the most common BS procedures. The primary objective of this study was to identify the risk of infection in LTX recipients with pre‐TXP RYGB. Methods Adult patients with LTX between 1/1/2001 and 9/30/2018 at our center were screened for pre‐TXP RYGB; patients with gastrectomy via sleeve or banding were excluded. Patients with no history of BS pre‐ or post‐transplant were placed in a comparator group, matched 2:1 via incidence density sampling on age epoch. Results There were 16 LTX recipients with pre‐TXP RYGB matched to 32 controls. Median time from RYGB to transplant was 11.7 years. Mean weight loss was 66 ± 19 kg. There were significantly more women with pre‐TXP RYGB than in the matched control (RYGB:68.8% vs control:25%, P = .009). Demographics were otherwise similar between groups. Pre‐TXP RYGB did not significantly increase hospital or ICU length of stay (P = .5, P = .3) but was associated with a significantly increased rate of fungal infection at 1 year (RYGB:33.4% vs control:9.7%, P = .01), and a numerical trend to increased bacterial infection (RYGB:56.2% vs control:32.2%, P = .09). Conclusion Despite the substantial weight loss attributed to BS, patients with pre‐TXP RYGB demonstrated increased rates of fungal infection after transplant and trended toward increased bacterial infection. While the anatomical complexity associated with LTX surgery after RYGB did not appear to significantly affect ICU or hospital length of stay, it may have contributed to overall infectious risk, and possibly to impaired survival. Additionally, bypass of the host natural barrier defenses of the stomach could also have contributed to infectious risk. Our findings highlight the complexity of this patient population. Future prospective studies are needed to investigate risk of infection after LTX in the setting of pre‐Txp BS. Potential modification in fungal prophylaxis protocols to include pre‐TXP RYGB may be warranted.

show abstract

Obesity, transplantation, and bariatric surgery: An evolving solution for a growing epidemic

Cited by 58 publications

References 121 publications

Post-transplant obesity impacts long-term survival after liver transplantation

Post-transplant obesity impacts long-term survival after liver transplantation

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

Pre‐transplant bariatric surgery is associated with increased fungal infection after liver transplant

Contact Info

Product

Resources

About