Young Kim1, Amanda J Bailey1, Mackenzie C Morris1, Al-Faraaz Kassam1, Shimul A Shah1, Tayyab S Diwan2. 1. Cincinnati Collaborative for Obesity Research (CCORE), Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio. 2. Cincinnati Collaborative for Obesity Research (CCORE), Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio. Electronic address: tayyab.diwan@uc.edu.
Abstract
BACKGROUND: Morbid obesity serves as a barrier to kidney transplantation (KT) due to potential suboptimal posttransplant outcomes. Laparoscopic sleeve gastrectomy (LSG) has previously been shown to improve transplant eligibility through weight loss. OBJECTIVES: We aimed to examine the role LSG plays in improving patient outcomes postrenal transplantation, including possible impact on new-onset diabetes after transplant (NODAT). SETTING: University Hospital. METHODS: A single-center analysis was performed identifying all patients who underwent KT after LSG from 2011 to 2017 (n = 41). Exclusion criteria included type I diabetes and previous pancreas transplantation. NODAT was defined as a new insulin requirement after KT. Delayed graft function was defined as need for dialysis within the first week after KT. Mean posttransplant follow-up period was 22 months. RESULTS: Forty-one patients underwent KT after LSG after median time of 16 months. Median age of postLSG patients undergoing KT was 56.0 years at time of KT. Average body mass index decreased by 9 from the time of LSG to KT, and no patients regained weight at 1-year follow-up. After LSG, the number of patients with hypertension (85.4% versus 48.5%) and the number of antihypertensive medications used decreased significantly (1.6 versus .6) at time of KT (P < .001 each). At 1-year follow-up, the improvement in hypertension persisted (51.2% versus 48.5%, P = nonsignificant). The average insulin regimen decreased from 33.0 ± 51.6 to 11.7 ± 21.5 units at KT (P < .001). This improvement also persisted at 1-year follow-up (11.9 versus 11.7 units, P = nonsignificant). Zero patients suffered NODAT over the follow-up period (versus institutional rate of NODAT at 15.8%). One patient developed delayed graft function (2.4%, versus institutional rate of 13.3%). After 1 year postKT, there was 1 graft loss (2.4%) and no mortality. CONCLUSION: This is the largest reported series of KT after planned LSG in morbidly obese patients. Our results confirm excellent posttransplant outcomes among patients who otherwise would have been denied KT eligibility.
BACKGROUND: Morbid obesity serves as a barrier to kidney transplantation (KT) due to potential suboptimal posttransplant outcomes. Laparoscopic sleeve gastrectomy (LSG) has previously been shown to improve transplant eligibility through weight loss. OBJECTIVES: We aimed to examine the role LSG plays in improving patient outcomes postrenal transplantation, including possible impact on new-onset diabetes after transplant (NODAT). SETTING: University Hospital. METHODS: A single-center analysis was performed identifying all patients who underwent KT after LSG from 2011 to 2017 (n = 41). Exclusion criteria included type I diabetes and previous pancreas transplantation. NODAT was defined as a new insulin requirement after KT. Delayed graft function was defined as need for dialysis within the first week after KT. Mean posttransplant follow-up period was 22 months. RESULTS: Forty-one patients underwent KT after LSG after median time of 16 months. Median age of postLSG patients undergoing KT was 56.0 years at time of KT. Average body mass index decreased by 9 from the time of LSG to KT, and no patients regained weight at 1-year follow-up. After LSG, the number of patients with hypertension (85.4% versus 48.5%) and the number of antihypertensive medications used decreased significantly (1.6 versus .6) at time of KT (P < .001 each). At 1-year follow-up, the improvement in hypertension persisted (51.2% versus 48.5%, P = nonsignificant). The average insulin regimen decreased from 33.0 ± 51.6 to 11.7 ± 21.5 units at KT (P < .001). This improvement also persisted at 1-year follow-up (11.9 versus 11.7 units, P = nonsignificant). Zero patients suffered NODAT over the follow-up period (versus institutional rate of NODAT at 15.8%). One patient developed delayed graft function (2.4%, versus institutional rate of 13.3%). After 1 year postKT, there was 1 graft loss (2.4%) and no mortality. CONCLUSION: This is the largest reported series of KT after planned LSG in morbidly obesepatients. Our results confirm excellent posttransplant outcomes among patients who otherwise would have been denied KT eligibility.
Authors: Aleksandra Kukla; Tayyab Diwan; Byron H Smith; Maria L Collazo-Clavell; Elizabeth C Lorenz; Matthew Clark; Karen Grothe; Aleksandar Denic; Walter D Park; Sukhdeep Sahi; Carrie A Schinstock; Hatem Amer; Naim Issa; Andrew J Bentall; Patrick G Dean; Yogish C Kudva; Manpreet Mundi; Mark D Stegall Journal: Kidney360 Date: 2022-05-16
Authors: Loubna Outmani; Hendrikus J A N Kimenai; Joke I Roodnat; Marjolijn Leeman; Ulas L Biter; René A Klaassen; Jan N M IJzermans; Robert C Minnee Journal: Clin Transplant Date: 2021-01-09 Impact factor: 2.863
Authors: Gabriel C Oniscu; Daniel Abramowicz; Davide Bolignano; Ilaria Gandolfini; Rachel Hellemans; Umberto Maggiore; Ionut Nistor; Stephen O'Neill; Mehmet Sukru Sever; Muguet Koobasi; Evi V Nagler Journal: Nephrol Dial Transplant Date: 2021-12-24 Impact factor: 5.992
Authors: William P Martin; James White; Francisco J López-Hernández; Neil G Docherty; Carel W le Roux Journal: Front Endocrinol (Lausanne) Date: 2020-08-17 Impact factor: 5.555