Photo Credit: Rudzhan Nagiev
Referral of obese end-stage renal disease (ESRD) patients to metabolic and bariatric surgery (MBS) could offer a pathway to transplant, according to a study published online March 12 in the Journal of the American College of Surgery.
Noting that an elevated body mass index is a major cause of transplant preclusion in ESRD, Shauna Levy, M.D., from the Tulane University School of Medicine in New Orleans, and colleagues created a collaborative program for ESRD patients to undergo weight loss before obtaining a kidney transplant. A total of 183 patients were referred to the bariatric team by the transplant team; 36 underwent MBS (20 Roux-en-Y gastric bypass; 16 sleeve gastrectomy). Of these, 10 underwent subsequent transplantation and 15 are currently wait-listed.
The mean body mass index was 46.4 kg/m2 at the start and 33.9 kg/m2 at the time of transplant. The researchers observed a reduction in the average number of hypertension mediations from 2.0 to 1.0 presurgery to postsurgery, respectively. Similarly, improvement was seen in hemoglobin A1c levels, from 6.2 preoperatively to 5.2 postoperatively. All transplants are currently functioning, with median creatinine of 1.5 mg/dL.
“A collaborative effort with an MBS and transplant team offers a pathway for morbidly obese ESRD candidates who would otherwise be denied a transplant,” the authors write. “With increasing prevalences of obesity and ESRD in this country, we see this as a growing issue.”
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