3 years ago

Laparoscopic Sleeve Gastrectomy Improves Renal Transplant Candidacy and Post-Transplant Outcomes in Morbidly Obese Patients

D.P. Schauer, J.S. Tadros, V.K. Dhar, Y. Kim, A.R. Shields, T.S. Diwan, S.A. Shah, M.C. Cuffy, A.D. Jung, E.S. Woodle, E.P. Smith, R.R. Alloway, D.J. Hanseman
Morbid obesity is a barrier to KT due to inferior outcomes, including higher rates of new-onset diabetes after transplantation (NODAT), delayed graft function (DGF), and graft failure. LSG increases transplant eligibility by reducing body mass index (BMI) in KT candidates, but the effect of surgical weight loss on post-transplant outcomes is unknown. Reviewing single-center medical records, we identified all patients who underwent LSG prior to KT from 2011-2016 (n=20). Post-LSG kidney recipients were compared with similar-BMI recipients who did not undergo LSG, using 2:1 direct matching for patient factors. McNemar's test and signed-rank test were used to compare groups. Among post-LSG patients, mean BMI was 41.5±4.4 kg/m2 at initial encounter, which decreased to 32.3±2.9 kg/m2 prior to KT (p<0.01). No complications, readmissions, or mortality occurred following LSG. After KT, one patient (5%) experienced DGF, and no patients experienced NODAT. Allograft and patient survival at one year was 100%. Compared with non-LSG patients, post-LSG recipients had lower rates of DGF (5% vs 20%) and renal dysfunction-related readmissions (10% vs 27.5%) (p<0.05 each). Perioperative complications, allograft survival, and patient survival were similar between groups. These data suggest morbidly obese ESRD patients who undergo LSG to improve transplant candidacy, achieve excellent post-transplant outcomes. This article is protected by copyright. All rights reserved.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1111/ajt.14463

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