title: Improvement of graft function following Roux-en-Y gastric bypass surgery in a morbidly obese kidney recipient: a case report and literature review.
abstract: BACKGROUND
  Transplantation is the best and approved method of renal replacement therapy. Graft function depends not only on proper regulation of immune processes but also on the optimal control of chronic diseases. The obesity epidemic involves the healthy population and organ recipients equally. Obesity and metabolic syndrome lead to a number of disorders exerting adverse effects on the transplanted organ.
  
  
  METHODS
  We report a case of a kidney recipient, 12 years after transplantation, with chronic graft failure (serum creatinine level 2.1 mg/dl, GFR 31 ml/min/1.73 m(2)), morbid obesity (weight 139.8 kg, BMI 46.2 kg/m(2), excess body mass 73.1 kg), hypertension, poorly controlled type 1 diabetes (HbA1c 8.8%), and ischemic heart disease. The cause of chronic kidney disease was diabetic nephropathy. The patient was the first Polish kidney recipient referred for bariatric gastric bypass surgery (GB). Directly after surgery, transient creatinine elevation (4.7 mg/dl) was noted. There was no reduction in diuresis. Desired weight loss was achieved within 12 months after surgery (body mass 81.9, BMI 27.1 kg/m(2), percentage loss of excess weight 86.9%) with improved graft function (serum creatinine level 1.3 mg/dl, GFR 45.1 ml/min/1.73 m(2)) and reduction of daily insulin requirement from 74 to 40 units. The severity of hypertension and ischemic heart disease diminished as well.
  
  
  CONCLUSIONS
  Metabolic surgery is the best treatment of obesity and may contribute to post-transplantation care if weight gain is observed, as a result of the interaction of many factors leading to deterioration of renal graft function.
authors.affiliation: Department of General Surgery and Transplantology, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Paweł
authors.initials: P
authors.lastname: Ziemiański
authors.affiliation: Department of General Surgery and Transplantology, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Lisik
authors.affiliation: Department of General Surgery and Transplantology, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Rafał J
authors.initials: RJ
authors.lastname: Marszałek
authors.affiliation: Department of Immunology, Transplantology and Internal Diseases, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Cieciura
authors.affiliation: Department of Internal Diseases and Cardiology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Justyna
authors.initials: J
authors.lastname: Domienik-Karłowicz
authors.affiliation: 1st Department of Anesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Janusz
authors.initials: J
authors.lastname: Trzebicki
authors.affiliation: Department of General Surgery and Transplantology, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Gryczewski
authors.affiliation: Department of General Surgery and Transplantology, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Wierzbicki
authors.affiliation: Department of General Surgery and Transplantology, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Kosieradzki
authors.affiliation: Department of Transplant Medicine and Nephrology, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Durlik
authors.affiliation: Department of Internal Diseases and Cardiology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Pruszczyk
authors.affiliation: Department of General Surgery and Transplantology, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Chmura
mesh_terms: D000328:Adult; D003928:Diabetic Nephropathies / Q000150:complications / Q000601:surgery*; D015390:Gastric Bypass; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery*; D016030:Kidney Transplantation; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*