Skip to main content
SpringerLink
Log in

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

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. U.S. Renal Data System. USRDS 2011 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. Bethesda: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2011.

    Google Scholar 

  2. Wang Y, Chen W, Klag M, et al. Epidemic of childhood obesity: implications for kidney disease. Adv in Chronic Kidney Dis. 2006;13(4):336–51.

    Article  Google Scholar 

  3. Kramer H, Luke A. Obesity and kidney disease: a big dilemma. Current Opinion in Nephr and Hypert. 2007;16:237. 41

    Article  Google Scholar 

  4. Friedman A, Miskulin D, Rosenberg I, et al. Demographics and trends in overweight and obesity in patients at time of kidney transplantation. Am J Kidney Dis. 2003;41(2):480–7.

    Article  PubMed  Google Scholar 

  5. Kunz K, Hannedouche T. Obesity in hemodialysis: the paradox. Nephro Ther. 2009;5(5):S339–45.

    Article  Google Scholar 

  6. Newcombe V. Laparoscopic adjustable gastric banding prior to renal transplantation. Obes Surg. 2005;15(4):567–70.

    Article  PubMed  Google Scholar 

  7. Cacciola RAS, Pujar K, Ilham MA, et al. Effect of degree of obesity on renal transplant outcome. Transplant Proc. 2008;40:3408–12.

    Article  CAS  PubMed  Google Scholar 

  8. Jindal RM, Zewada ET. Obesity and kidney transplantation. Am J Kidney Dis. 2004;43(6):943–52.

    Article  PubMed  Google Scholar 

  9. Gore JL, Pham PT, Danovitch GM, et al. Obesity and outcome following renal transplantation. Am J Transplant. 2006;6(2):357–63.

    Article  CAS  PubMed  Google Scholar 

  10. Meier-Krieche HU, Arndorfer JA, Kaplan B. The impact of body mass index on renal transplant outcomes: a significant independent risk factor for graft failure and patient death. Transplantation. 2003;75(2):249.

    Article  Google Scholar 

  11. Glanton CW, Pham PT, Danovitch GM, et al. Impact of renal transplantation on survival in end stage renal disease patients with elevated body mass index. Kidney Int. 2003;63:647.

    Article  PubMed  Google Scholar 

  12. Segev DL, Simpkins CE, Thompson RE, et al. Obesity impacts to kidney transplantation. J Am Sic nephrol. 2008;19:349.

    Article  Google Scholar 

  13. Modanlou KA, Muthyala U, Xiao H, et al. Bariatric surgery among kidney transplant candidates and recipients: analysis of the United States renal data system and literature review. Transplantation. 2009;87(8):1–7.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, University of South Florida-Health, Tampa General Hospital, Tampa, FL, USA

    Shadi Al-Bahri, Tannous K. Fakhry, John Paul Gonzalvo & Michel M. Murr

Authors
  1. Shadi Al-Bahri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tannous K. Fakhry
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John Paul Gonzalvo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michel M. Murr
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shadi Al-Bahri.

Ethics declarations

Conflict of Interest

The authors have no financial affiliations to disclose.

Ethical Standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The article does not include any studies with animals performed by any of the authors.

Informed Consent

Informed consent was obtained from all individual participants included in this study.

Additional information

Suggested reviewers are Isaac Samuels, Samer Mattar, Brad Needleman, and Sabrena Noria.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Al-Bahri, S., Fakhry, T.K., Gonzalvo, J.P. et al. Bariatric Surgery as a Bridge to Renal Transplantation in Patients with End-Stage Renal Disease. OBES SURG 27, 2951–2955 (2017). https://doi.org/10.1007/s11695-017-2722-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-017-2722-6

Keywords

Search

Navigation