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13.05.2017 | Original Contributions | Ausgabe 11/2017

Obesity Surgery 11/2017

Bariatric Surgery as a Bridge to Renal Transplantation in Patients with End-Stage Renal Disease

Zeitschrift:
Obesity Surgery > Ausgabe 11/2017
Autoren:
Shadi Al-Bahri, Tannous K. Fakhry, John Paul Gonzalvo, Michel M. Murr
Wichtige Hinweise
Suggested reviewers are Isaac Samuels, Samer Mattar, Brad Needleman, and Sabrena Noria.

Abstract

Background

Obesity is a relative contraindication to organ transplantation. Preliminary reports suggest that bariatric surgery may be used as a bridge to transplantation in patients who are not eligible for transplantation because of morbid obesity.

Setting

The Bariatric Center at Tampa General Hospital, University of South Florida, Tampa, Florida.

Methods

We reviewed the outcomes of 16 consecutive patients on hemodialysis for end-stage renal disease (ESRD) who underwent bariatric surgery from 1998 to 2016. Demographics, comorbidities, weight loss, as well as transplant status were reported. Data is mean ± SD.

Results

Six men and ten women aged 43–66 years (median = 54 years) underwent laparoscopic Roux-en-Y gastric bypass (LRYGB, n = 12), laparoscopic adjustable gastric banding (LAGB, n = 3), or laparoscopic sleeve gastrectomy (LSG, n = 1). Preoperative BMI was 48 ± 8 kg/m2. Follow-up to date was 1–10 years (median = 2.8 years); postoperative BMI was 31 ± 7 kg/m2; %EBWL was 62 ± 24. Four patients underwent renal transplantation (25%) between 2.5–5 years after bariatric surgery. Five patients are currently listed for transplantation. Five patients were not listed for transplantation due to persistent comorbidities; two of these patients died as a consequence of their comorbidities (12.5%) more than 1 year after bariatric surgery. Two patients were lost to follow-up (12.5%).

Conclusion

Bariatric surgery is effective in patients with ESRD and improves access to renal transplantation. Bariatric surgery offers a safe approach to weight loss and improvement in comorbidities in the majority of patients. Referrals of transplant candidates with obesity for bariatric surgery should be considered early in the course of ESRD.

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