Sleeve Gastrectomy Compared with Gastric Bypass for Morbidly Obese Patients with End Stage Renal Disease: a Decision Analysis

Choudhury, Rashikh A.; Hoeltzel, Gerard D.; Prins, Kas; Chow, Eugene M.; Moore, Hunter B.; Lawson, Peter J.; Yoeli, Dor; Pratap, Akshay; Abt, Peter L.; Dumon, Kristoffel R.; Conzen, Kendra D.; Nydam, Trevor L.

doi:10.1007/s11605-019-04225-w

Cited by 16 publications

(17 citation statements)

References 61 publications

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“…Performing bariatric surgery prior to kidney transplant 25,26,40‐46 is a strategy which has been gaining popularity with the introduction of minimally invasive techniques and recent reports have demonstrated acceptable morbidity and mortality 24,47 The main disadvantage of this approach is that patients wait longer for a kidney transplant with increased morbidity and mortality while on dialysis 35 . By performing the sleeve gastrectomy simultaneously with kidney transplant, the patient can be transplanted sooner with only one procedure requiring general anesthesia.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous robotic kidney transplantation and bariatric surgery for morbidly obese patients with end-stage renal failure

Spaggiari

Cocco

Tulla

et al. 2021

American Journal of Transplantation

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Patients with obesity have limited access to kidney transplantation, mainly due to an increased incidence of surgical complications, which could be reduced with selective use of robotic‐assisted surgery. This prospective randomized controlled trial compares the safety and efficacy of combining robotic sleeve gastrectomy and robotic‐assisted kidney transplant to robotic kidney transplant alone in candidates with class II or III obesity. Twenty candidates were recruited, 11 were randomized to the robotic sleeve gastrectomy and robotic‐assisted kidney transplant group and 9 to the robotic kidney transplant group. At 12‐month follow‐up, change in body mass index was –8.76 ± 1.82 in the robotic sleeve gastrectomy and robotic‐assisted kidney transplant group compared to 1.70 ± 2.30 in the robotic kidney transplant group (P = .0041). Estimated glomerular filtration rate, serum creatinine, readmission rates, and graft failure rates up to 12 months were not different between the two groups. Length of surgery was longer in the robotic sleeve gastrectomy and robotic‐assisted kidney transplant group (405 minutes vs. 269 minutes, p = .00304) without increase in estimated blood loss (120 ml vs. 117 ml, p = .908) or incidence of surgical complications. Combined robotic‐assisted kidney transplant and sleeve gastrectomy is safe and effective compared to robotic‐assisted kidney transplant alone.

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Section: Discussionmentioning

confidence: 99%

Simultaneous robotic kidney transplantation and bariatric surgery for morbidly obese patients with end-stage renal failure

Spaggiari

Cocco

Tulla

et al. 2021

American Journal of Transplantation

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“…Our group has previously used the presented approach to transition probability creation in Markov decision analysis to estimate the impact of weight loss interventions for renal and liver transplant candidates [12][13][14][15].…”

Section: Systemic Tpa Pao 2 /Fio 2 Improvementmentioning

confidence: 99%

“…Markov models use existing published data to project the movement of patients through simulated health states over time [11]. Markov models have previously been used by our group and have been increasingly applied to model healthcare challenges for which trial data may be lacking for the foreseeable future [12][13][14][15]. As such, a Markov model was created to estimate the impact of salvage use systemic tPA on ARDS/COVID-19 patients in addition to a more aggressive use for interventions at an earlier state of disease progression.…”

Section: Introductionmentioning

confidence: 99%

Salvage use of tissue plasminogen activator (tPA) in the setting of acute respiratory distress syndrome (ARDS) due to COVID-19 in the USA: a Markov decision analysis

et al. 2020

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Background: COVID-19 threatens to quickly overwhelm our existing critical care infrastructure in the USA. Systemic tissue plasminogen activator (tPA) has been previously demonstrated to improve PaO 2 /FiO 2 (mmHg) when given to critically ill patients with acute respiratory distress syndrome (ARDS). It is unclear to what extent tPA may impact population-based survival during the current US COVID-19 pandemic. Methods: A decision analytic Markov state transition model was created to simulate the life critically ill COVID-19 patients as they transitioned to either recovery or death. Two patient groups were simulated (50,000 patients in each group); (1) Patients received tPA immediately upon diagnosis of ARDS and (2) patients received standard therapy for ARDS. Base case critically ill COVID-19 patients were defined as having a refractory PaO 2 /FiO 2 of < 60 mmHg (salvage use criteria). Transition from severe to moderate to mild ARDS, recovery, and death were estimated. Markov model parameters were extracted from existing ARDS/COVID-19 literature. Results: The use of tPA was associated with reduced mortality (47.6% [tTPA] vs. 71.0% [no tPA]) for base case patients. When extrapolated to the projected COVID-19 eligible for salvage use tPA in the USA, peak mortality (deaths/100,000 patients) was reduced for both optimal social distancing (70.5 [tPA] vs. 75.0 [no tPA]) and no social distancing (158.7 [tPA] vs. 168.8 [no tPA]) scenarios.Conclusions: Salvage use of tPA may improve recovery of ARDS patients, thereby reducing COVID-19-related mortality and ensuring sufficient resources to manage this pandemic.

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“…Both procedures achieve a significant excess body weight loss (up to 80% within 24 months); to date there are no prospective randomized studies comparing the two procedures. In a recent analysis on the ESRD population, Choudhury et al [110], using a probabilistic Markov model, conclude that RYGB improves access to renal transplantation and thereby increases long-term survival. However, at present, the preferred approach is LSG [110][111][112][113][114].…”

Section: Pretransplantmentioning

confidence: 99%

“…, using a probabilistic Markov model, conclude that RYGB improves access to renal transplantation and thereby increases long‐term survival. However, at present, the preferred approach is LSG . LSG offers several advantages over RYGB .…”

Section: Strategies For Weight Management Of Esrd Patients and Kidneymentioning

confidence: 99%

Obesity in kidney transplantation

et al. 2019

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The prevalence of obesity among patients with chronic kidney disease continues to increase as a reflection of the trend observed in the general population. Factors affecting the access to the waiting list and the transplantability of this specific population will be analysed. From observational studies, kidney transplantation in obese patients carries an increased risk of surgical complications compared to the nonobese population; therefore, many centres have been reluctant to proceed with transplantation, despite this treatment modality confers a survival advantage over dialysis. As a consequence, obese patients continue to face decreased access to the waiting list, with a lower likelihood of being transplanted and higher waiting times when compared to the nonobese candidates. In this review will be described the current strategies for treatment of obesity in different settings (pretransplant, at transplant and post-transplant). Obesity represents a risk factor for surgical complications but not a contraindication for kidney transplantation; outcomes could be greatly improved with its multidisciplinary and multimodal treatment. The modern technology with minimally invasive techniques, mainly using robotic platform, allows a reduction in the surgical complications rate, with graft and patient survival rates comparable to the nonobese counterpart.

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Sleeve Gastrectomy Compared with Gastric Bypass for Morbidly Obese Patients with End Stage Renal Disease: a Decision Analysis

Cited by 16 publications

References 61 publications

Simultaneous robotic kidney transplantation and bariatric surgery for morbidly obese patients with end-stage renal failure

Simultaneous robotic kidney transplantation and bariatric surgery for morbidly obese patients with end-stage renal failure

Salvage use of tissue plasminogen activator (tPA) in the setting of acute respiratory distress syndrome (ARDS) due to COVID-19 in the USA: a Markov decision analysis

Obesity in kidney transplantation

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