Bariatric surgery among kidney transplant candidates and recipients: analysis of the United States renal data system and literature review.
BACKGROUND
Limited data exist on the safety and efficacy of bariatric surgery (BS) in patients with kidney failure.


METHODS
We examined Medicare billing claims within USRDS registry data (1991-2004) to identify BS cases among renal allograft candidates and recipients.


RESULTS
Of 188 BS cases, 72 were performed pre-listing, 29 on the waitlist, and 87 post-transplant. Roux-en-Y gastric bypass was the most common procedure. Thirty-day mortality after BS performed on the waitlist and post-transplant was 3.5%, and one transplant recipient lost their graft within 30 days after BS. BMI data were available for a subset and suggested median excess body weight loss of 31%-61%. Comparison to published clinical trials of BS in populations without kidney disease indicates comparable weight loss but higher post-BS mortality in the USRDS sample.


CONCLUSIONS
Given the substantial contributions of obesity to excess morbidity and mortality, BS warrants prospective study as a strategy for improving outcomes before and after kidney transplantation.
Modanlou
Kian A
KA
Division of Abdominal Organ Transplantation, Department of Surgery, Saint Louis University Medical Center, St. Louis, MO 63130, USA.
Muthyala
Umadevi
U
Xiao
Huiling
H
Schnitzler
Mark A
MA
Salvalaggio
Paolo R
PR
Brennan
Daniel C
DC
Abbott
Kevin C
KC
Graff
Ralph J
RJ
Lentine
Krista L
KL
D000328:Adult; D050110:Bariatric Surgery / Q000401:mortality / Q000706:statistics & numerical data*; D015992:Body Mass Index; D005260:Female; D015390:Gastric Bypass / Q000379:methods; D015391:Gastroplasty / Q000379:methods; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000601:surgery*; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009767:Obesity, Morbid / Q000150:complications* / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012042:Registries; D012449:Safety; D015996:Survival Rate; D017741:Survivors; D014481:United States; D015431:Weight Loss