Outcomes of kidney transplant recipients who underwent pre-transplant bariatric surgery for severe obesity: a long-term follow-up study

Abstract

Background Kidney transplantation (KT) is the preferred therapy for end-stage renal disease (ESRD). While a major cause for ESRD, obesity is also a key obstacle to candidacy for KT. Bariatric surgery, particularly sleeve gastrectomy (SG), is increasingly used to improve access to KT in patients with obesity, but the literature especially on outcomes post-KT remains lacking. We aimed to provide a long-term follow-up analysis of efficacy and outcomes of a previously described cohort of patients with obesity, who had SG as a means for access to KT. Methods This is a single-center retrospective follow-up study of 32 patients with advanced chronic kidney disease or ESRD, who were referred and underwent SG between 2013 and 2018 as an access strategy to KT. The primary outcome was successful KT. Ninety-day outcomes, long-term graft function, and changes in weight and obesity-related comorbidities after KT were assessed. Descriptive statistics are presented as count (percentage) or median (interquartile range). Results At baseline, 18 (56%) were male with a median age and BMI of 51 (11) years and 42.3 (5.2) kg/m 2 , respectively. Median follow-up time post-SG was 53 (58) months. At last follow-up, 23 (72%) patients received KT. Median time to KT was 16 (20) months and BMI was 34.0 (5.1) kg/m 2 at time of transplant. At KT, 13 (57%) and 20 (87%) had diabetes and hypertension, respectively. Median follow-up post-KT was 16 (47) months. There was one graft loss requiring return to dialysis. At 5-year post-KT, median serum creatinine was 136 (66) µmol/l. At last follow-up post-KT, median BMI remained at 33.7 (7.6) kg/m 2 . Among patients with diabetes and hypertension, 7/13 (54%) and 5/20 (25%) had either improvement or remission of their comorbidities, respectively. Conclusion SG is an effective strategy to improve access to KT in patients with severe obesity. Transplant recipients also continue to benefit from sustained weight loss and improved related comorbidities that may positively impact their graft function after KT. Graphical abstract

Impact of bariatric surgery on total knee arthroplasty

“…18 While the non-bariatric surgery groups had higher BMIs before arthroplasty than the bariatric surgery groups, the difference varied from 0 kg/m 2 to 25 to 7.6 kg/m 2 . 19 Thus, in studies as Martin, Watts, and Taunton's, there was minimal variation in mean BMI between the two groups. Because of inadequate reporting of past non-bariatric treatment of obesity in these patients, it is uncertain if bariatric surgery gives extra benefit over and above non-surgical treatments to weight loss prior to arthroplasty.…”

The effectiveness and safety of bariatric surgery in individuals with end-stage renal disease: a systematic review and meta-analysis

“…As mentioned before, the bene t of BS in ESRD who are obese and overweight is obscure; on one hand, some studies report that weight loss in obese ESRD is linked to adverse outcomes (such as cardiomyopathy, arrhythmias, and sudden death), which dramatically denies the application of BS in obese ESRD patients [17] ; on the other hand, other studies a rm the elevated access to transplantation and decreased posttransplant morbidity and mortality in obese ESRD patients who receive the BS [18][19][20] . To facilitate the transition for these patients towards KTX, it is imperative to conduct a thorough evaluation of BS [35,36] .…”

“…Subsequently, 14 studies were excluded, including 7 studies that reported the results were obtained by the fusion of multiple renal diseases that not only end-stage renal disease, four studies reported other organ transplantation that was not kidney transplantation, two studies were not published in English, and 1 study with non-accessible full-text. Finally, 17 studies were included in the meta-analysis [7,9,10,20,[22][23][24][25][26][27][28][29][30][31][32][33][34] (Fig. 1).…”

“…Among the included 17 studies, nine originated from the United States, while the remaining were from diverse countries such as Australia, France, and Canada. These literatures mainly consisted of retrospective cohort studies and case series [7,9,10,20,[22][23][24][25][26][27][28][29][30][31][32][33][34] . The sample size varied among these studies, ranging from 3-243 patients with a mean age ranging from 41.0 to 56.0 years.…”

“…For instance, the enduring obesity paradox suggests that individuals with a higher BMI tend to exhibit better outcomes compared to those with a lower BMI, especially in the context of patients with ESRD, which seems a certain doubt in receiving the BS in obese ESRD patients [17] . However, other studies exhibit that the BS could improve the listed KTX rate and long-term outcomes in obese ESRD patients [18][19][20] . Therefore, it is still necessary to explore the operative feasibility of BS in obese ESRD patients who are ongoing to receive the KTX.…”