OBJECTIVE: To describe the outcomes of kidney transplant (KT) candidates with obesity undergoing sleeve gastrectomy (SG) to meet the criteria for KT. METHODS: Retrospective analysis was conducted of electronic medical records of KT candidates with obesity (body mass index >35 kg/m2) who underwent SG in our institution. Weight loss, adverse health events, and the listing and transplant rates were abstracted and compared with the nonsurgical cohort. RESULTS: The SG was performed in 54 patients; 50 patients did not have surgery. Baseline demographic characteristics were comparable at the time of evaluation. Mean body mass index ± SD of the SG group was 41.7±3.6 kg/m2 at baseline (vs 41.5±4.3 kg/m2 for nonsurgical controls); at 2 and 12 months after SG, it was 36.4±4.1 kg/m2 and 32.6±4.0 kg/m2 (P<.01 for both). In the median follow-up time of 15.5 months (interquartile range, 6.4 to 23.9 months), SG was followed by active listing (37/54 people), and 20 of 54 received KT during a median follow-up time of 20.9 months (interquartile range, 14.7 to 28.3 months) after SG. In contrast, 14 of 50 patients in the nonsurgical cohort were listed, and 5 received a KT (P<.01). Three patients (5.6%) experienced surgical complications. There was no difference in overall hospitalization rates and adverse health outcomes, but the SG cohort experienced a higher risk of clinically significant functional decline. CONCLUSION: In KT candidates with obesity, SG appears to be effective, with 37% of patients undergoing KT during the next 18 months (P<.01). Further research is needed to confirm and to improve the safety and efficacy of SG for patients with obesity seeking a KT.

Department of Cardiovascular Surgery Research Mayo Clinic Rochester MN

Department of Health Sciences Research Mayo Clinic Rochester MN

Department of Psychiatry and Psychology Mayo Clinic Rochester MN

Department of Pulmonary Medicine Mayo Clinic Rochester MN

Division of Endocrinology Diabetes Metabolism and Nutrition Department of Medicine Mayo Clinic Rochester MN

Division of Endocrinology Diabetes Metabolism and Nutrition Department of Medicine Mayo Clinic Rochester MN; Department of Psychiatry and Psychology Mayo Clinic Rochester MN

Division of Nephrology and Hypertension Department of Medicine Mayo Clinic Rochester MN

Division of Nephrology and Hypertension Department of Medicine Mayo Clinic Rochester MN; Department of Urology University Hospital Hradec Kralove Hradec Kralove Czech Republic; Faculty of Medicine in Hradec Kralove Charles University Hradec Kralove Czech Republic

Division of Nephrology and Hypertension Department of Medicine Mayo Clinic Rochester MN; Von Liebig Transplant Center Mayo Clinic Rochester MN

Von Liebig Transplant Center Mayo Clinic Rochester MN; Department of Surgery and Immunology Mayo Clinic Rochester MN

Zobrazit více v PubMed

Chapter 1: Definition and classification of CKD. Kidney Int Suppl. 2013;3(1):19–62. PubMed PMC

Wakam GK, Sheetz KH, Gerhardinger L, Montgomery JR, Waits SA. Population-based trends in obesity and kidney transplantation among patients with end-stage kidney disease. Transplant Direct. 2021;7(12):e787. PubMed PMC

Centers for Disease Control and Prevention. Defining Adult Overweight & Obesity. Accessed August 25, 2023. https://www.cdc.gov/obesity/basics/adult-defining.html

Ladhani M, Craig JC, Irving M, Clayton PA, Wong G. Obesity and the risk of cardiovascular and all-cause mortality in chronic kidney disease: a systematic review and meta-analysis. Nephrol Dial Transplant. 2017;32(3):439–449. PubMed

Alothman S, Cornejo J, Adrales G, Li C, Sebastian R. Comparative outcomes of bariatric surgery in patients with ESRD on dialysis in the modern era of renal transplantation: analysis using the 2015-020 MBSAQIP database. Surg Endosc. 2023;37(9):7106–7113. PubMed

Kassam AF, Mirza A, Kim Y, et al. Long-term outcomes in patients with obesity and renal disease after sleeve gastrectomy. Am J Transplant. 2020;20(2):422–429. PubMed

Kukla A, Kudva YC, Navratil P, et al. Management of patients with kidney disease undergoing bariatric surgery: a multidisciplinary approach. Mayo Clin Proc. 2024;99(3):445–458. PubMed

Guralnik J, Bandeen-Roche K, Bhasin SA, et al. Clinically meaningful change for physical performance: perspectives of the ICFSR Task Force. J Frailty Aging. 2020;9(1):9–13. PubMed PMC

Jang IY, Jung HW, Lee HY, Park H, Lee E, Kim DH. Evaluation of clinically meaningful changes in measures of frailty. J Gerontol A Biol Sci Med Sci. 2020;75(6):1143–1147. PubMed PMC

Korakas E, Kountouri A, Raptis A, Kokkinos A, Lambadiari V. Bariatric surgery and type 1 diabetes: unanswered questions. Front Endocrinol (Lausanne). 2020;11:525909. PubMed PMC

Workgroup on Hypoglycemia, American Diabetes Association. Defining and reporting hypoglycemia in diabetes: a report from the American Diabetes Association Workgroup on Hypoglycemia. Diabetes Care. 2005;28(5):1245–1249. PubMed

Elhakeem A, Hughes RA, Tilling K, et al. Using linear and natural cubic splines, SITAR, and latent trajectory models to characterise nonlinear longitudinal growth trajectories in cohort studies. BMC Med Res Methodol. 2022;22(1):68. PubMed PMC

von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007;335(7624):806–808. PubMed PMC

Kukla A, Diwan T, Smith BH, et al. Guiding kidney transplantation candidates for effective weight loss: a clinical cohort study. Kidney 360. 2022;3(8):1411–1416. PubMed PMC

Dixon JB, O’Brien PE. Health outcomes of severely obese type 2 diabetic subjects 1 year after laparoscopic adjustable gastric banding. Diabetes Care. 2002;25(2):358–363. PubMed

Wittgrove AC, Clark GW. Laparoscopic gastric bypass, Rouxen-Y—500 patients: technique and results, with 3-60 month follow-up. Obes Surg. 2000;10(3):233–239. PubMed

Rubino D, Abrahamsson N, Davies M, et al. Effect of continued weekly subcutaneous semaglutide vs placebo on weight loss maintenance in adults with overweight or obesity: the STEP 4 randomized clinical trial. JAMA. 2021;325(14):1414–1425. PubMed PMC

Davies M, Færch L, Jeppesen OK, et al. Semaglutide 2$4 mg once a week in adults with overweight or obesity, and type 2 diabetes (STEP 2): a randomised, double-blind, double-dummy, placebo-controlled, phase 3 trial. Lancet. 2021;397(10278):971–984. PubMed

Degoulet P, Legrain M, Réach I, Aimé F, Devriés C, Rojas P, Jacobs C. Mortality risk factors in patients treated by chronic hemodialysis. Report of the Diaphane collaborative study. Nephron. 1982;31(2):103–10. doi: 10.1159/000182627. PubMed DOI

Sheetz KH, Gerhardinger L, Dimick JB, Waits SA. Bariatric surgery and long-term survival in patients with obesity and endstage kidney disease. JAMA Surg. 2020;155(7):581–588. PubMed PMC

Coleman KJ, Shu YH, Fischer H, Johnson E, Yoon TK, Taylor B, Imam T, DeRose S, Haneuse S, Herrinton LJ, Fisher D, Li RA, Theis MK, Liu L, Courcoulas AP, Smith DH, Arterburn DE, Friedman AN. Bariatric Surgery and Risk of Death in Persons With Chronic Kidney Disease. Ann Surg. 2022. Dec 1;276(6):e784–e791. doi: 10.1097/SLA.0000000000004851. Epub 2021 Mar 1. PubMed DOI PMC

Voican CS, Lebrun A, Maitre S, et al. Predictive score of sarcopenia occurrence one year after bariatric surgery in severely obese patients. PLoS One. 2018;13(5):e0197248. PubMed PMC

Ibacache-Saavedra P, Jerez-Mayorga D, Carretero-Ruiz A, Miranda-Fuentes C, Cano-Cappellacci M, Artero EG. Effects of bariatric surgery on cardiorespiratory fitness: a systematic review and meta-analysis. Obes Rev. 2022;23(3):e13408. PubMed

Vibarel-Rebot N, Asselin M, Amiot V, Collomp K. Short-term effect of bariatric surgery on cardiorespiratory response at submaximal, ventilatory threshold, and maximal exercise in women with severe obesity. Obes Surg. 2023;33(5):1528–1535. PubMed

Fipps DC, Sinha S, Diwan TS, Clark MM. Psychosocial considerations in the combined bariatric surgery and organ transplantation population: a review of the overlapping pathologies and outcomes. Curr Opin Organ Transplant. 2022;27(6):514–522. PubMed

Denhaerynck K, Manhaeve D, Dobbels F, Garzoni D, Nolte C, De Geest S. Prevalence and consequences of nonadherence to hemodialysis regimens. Am J Crit Care. 2007;16(3):222–235 [quiz: 236]. PubMed

Johansen KL, Chertow GM, Kutner NG, Dalrymple LS, Grimes BA, Kaysen GA. Low level of self-reported physical activity in ambulatory patients new to dialysis. Kidney Int. 2010;78(11):1164–1170. PubMed PMC

DeJesus RS, Clark MM, Finney Rutten LJ, et al. Impact of a 12-week wellness coaching on self-care behaviors among primary care adult patients with prediabetes. Prev Med Rep. 2018;10:100–105. PubMed PMC

Benzo R, Hoult J, McEvoy C, et al. Promoting chronic obstructive pulmonary disease wellness through remote monitoring and health coaching: a clinical trial. Ann Am Thorac Soc. 2022;19(11):1808–1817. PubMed PMC

Sanguankeo A, Upala S. Metabolic syndrome increases mortality risk in dialysis patients: a systematic review and meta-analysis. Int J Endocrinol Metab. 2018;16(2):e61201. PubMed PMC

Kukla A, Alexander MP, Turkevi-Nagy S, et al. Mesangial expansion at 5 years predicts death and death-censored graft loss after renal transplantation. Clin Transplant. 2021;35(1):e14147. PubMed

Weir MR, Burgess ED, Cooper JE, et al. Assessment and management of hypertension in transplant patients. J Am Soc Nephrol. 2015;26(6):1248–1260. PubMed PMC

Kasiske BL, Anjum S, Shah R, et al. Hypertension after kidney transplantation. Am J Kidney Dis. 2004;43(6):1071–1081. PubMed

Carpenter MA, John A, Weir MR, et al. BP, cardiovascular disease, and death in the Folic Acid for Vascular Outcome Reduction in Transplantation trial. J Am Soc Nephrol. 2014;25(7):1554–1562. PubMed PMC

Riddle MC, Cefalu WT, Evans PH, et al. Consensus report: definition and interpretation of remission in type 2 diabetes. Diabetes Care. 2021;44(10):2438–2444. PubMed PMC

Gallagher EJ, Le Roith D, Bloomgarden Z. Review of hemoglobin A1c in the management of diabetes. J Diabetes. 2009;1(1):9–17. PubMed