title: Laparoscopic bariatric surgery improves candidacy in morbidly obese patients awaiting transplantation.
abstract: BACKGROUND
  To evaluate, at a university tertiary referral center, the safety and efficacy of laparoscopic Roux-en-Y gastric bypass (LRYGB) in patients with end-stage renal disease (ESRD) and laparoscopic sleeve gastrectomy (LSG) in patients with cirrhosis or end-stage lung disease (ESLD); and to determine whether these procedures help patients become better candidates for transplantation.
  
  
  METHODS
  A retrospective review was performed of selected patients with end-stage organ failure who were not eligible for transplantation because of morbid obesity who underwent LRYGB or LSG. The prospectively collected data included demographics, operative details, complications, percentage of excess weight loss, postoperative laboratory data, and status of transplant candidacy.
  
  
  RESULTS
  Of the 15 patients, 7 with ESRD underwent LRYGB and 6 with cirrhosis and 2 with ESLD underwent LSG. Complications developed in 2 patients (both with cirrhosis); no patient died. The mean follow-up was 12.4 months, and the mean percentage of excess weight loss at > or =9 months was 61% (ESRD), 33% (cirrhosis), and 61.5% (ESLD). Obesity-associated co-morbidities improved or resolved in all patients. Serum albumin and other nutritional parameters at > or =9 months after surgery were similar to the preoperative levels in all 3 groups. At the most recent follow-up visit, 14 (93%) of 15 patients had reached our institution's body mass index limit for transplantation and were awaiting transplantation; 1 patient with ESLD underwent successful lung transplant.
  
  
  CONCLUSIONS
  The results of this pilot study have provided preliminary evidence that LRYGB in patients with ESRD and LSG in patients with cirrhosis or ESLD is safe, well-tolerated, and improves their candidacy for transplantation.
authors.affiliation: Department of Surgery, University of California, San Francisco, School of Medicine, San Francisco, California, USA.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Takata
authors.forename: Guilherme M
authors.initials: GM
authors.lastname: Campos
authors.forename: Ruxandra
authors.initials: R
authors.lastname: Ciovica
authors.forename: Charlotte
authors.initials: C
authors.lastname: Rabl
authors.forename: Stanley J
authors.initials: SJ
authors.lastname: Rogers
authors.forename: John P
authors.initials: JP
authors.lastname: Cello
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Ascher
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Posselt
mesh_terms: D000328:Adult; D000713:Anastomosis, Roux-en-Y; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery*; D016030:Kidney Transplantation; D010535:Laparoscopy; D008103:Liver Cirrhosis / Q000150:complications / Q000601:surgery*; D016031:Liver Transplantation; D008171:Lung Diseases / Q000150:complications / Q000601:surgery*; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D010865:Pilot Projects; D012189:Retrospective Studies