Laparoscopic sleeve gastrectomy: gateway to kidney transplantation

Background: The prevalence of obesity and obesity-related morbidity in end-stage renal disease patients is rising. Although it is established that obesity does not abrogate the transplant benefit with respect to lower long-term mortality and cardiovascular risk, it is associated with increased graft failure, delayed graft function, surgical complications, prolonged hospital stay, and costs. Objectives: To examine the safety and efficacy of LSG (laparoscopic sleeve gastrectomy) in renal transplant candidates and evaluate transplant outcomes. Setting: Single-center prospective nonrandomized trial Methods: We here report on a prospective single-center trial establishing a 2-step approach for obese renal transplant candidates. Patients with end-stage renal disease and a BMI (body mass index) of 35 kg/m(2) or higher underwent laparoscopic sleeve gastrectomy. After reaching a BMI of <35 kg/m(2), patients were waitlisted for kidney transplantation. Age, gender, body mass index (BMI), associated co-morbidities, cause of end-stage renal disease, surgical complications, and outcome after kidney transplantation (graft survival, incidence of delayed graft function, incidence of rejection, serum creatinine) were collected. Results: LSG was performed in 8 renal transplant candidates with a mean BMI of 38.8 kg/m(2) each. BMI dropped to below 35 kg/m(2) within a median of 3 months. Percent excess body mass index loss (%BBMIL) was 62.7% at 1 year after LSG. Within 17 months (mean) after metabolic surgery, 7 patients underwent kidney transplantation. All transplants were successful with a serum creatinine of 1.9 +/- .8 mg/dL at discharge and stable allograft function thereafter. Mean follow-up was 3.2 +/- 1.4 years; no patient was lost to follow-up. Conclusion: LSG is safe and efficacious for treatment of obesity in renal transplant candidates. Rapid and sustained weight loss and subsequent waitlisting for kidney transplantation may reduce overall and in particular posttransplant patient morbidity. (C) 2017 American Society for Metabolic and Bariatric Surgery. All rights reserved.