title: Addressing morbid obesity as a barrier to renal transplantation with laparoscopic sleeve gastrectomy.
abstract: Morbid obesity is a barrier to renal transplantation and is inadequately addressed by medical therapy. We present results of a prospective evaluation of laparoscopic sleeve gastrectomy (LSG) for patients failing to achieve significant weight loss with medical therapy. Over a 25-month period, 52 obese renal transplant candidates meeting NIH guidelines for metabolic surgery underwent LSG. Mean age was 50.0 ± 10.0 years with an average preoperative BMI of 43.0 ± 5.4 kg/m(2) (range 35.8-67.7 kg/m(2)). Follow-up after LSG was 220 ± 152 days (range 26-733 days) with last BMI of 36.3 ± 5.3 kg/m(2) (range 29.2-49.8 kg/m(2)) with 29 (55.8%) patients achieving goal BMI of <35 kg/m(2) at 92 ± 92 days (range 13-420 days). The mean percentage of excess weight loss (%EWL) was 32.1 ± 17.6% (range 6.7-93.8%). A segmented regression model was used to compare medical therapy versus LSG. This revealed a statistically significant increase in the BMI reduction rate (0.3 kg/m(2)/month versus 1.1 kg/m(2)/month, p < 0.0001). Patients also experienced a 40.9% decrease in anti-hypertensive medications (p < 0.001) and a 49.7% decrease in total daily insulin dose (p < 0.001). LSG is a safe and effective means for addressing obesity in kidney transplant candidates in the context of a multidisciplinary approach.
authors.affiliation: Department of Surgery, Division of Transplantation, University of Cincinnati College of Medicine, Cincinnati, OH.
authors.forename: C M
authors.initials: CM
authors.lastname: Freeman
authors.forename: E S
authors.initials: ES
authors.lastname: Woodle
authors.forename: J
authors.initials: J
authors.lastname: Shi
authors.forename: J W
authors.initials: JW
authors.lastname: Alexander
authors.forename: P L
authors.initials: PL
authors.lastname: Leggett
authors.forename: S A
authors.initials: SA
authors.lastname: Shah
authors.forename: F
authors.initials: F
authors.lastname: Paterno
authors.forename: M C
authors.initials: MC
authors.lastname: Cuffy
authors.forename: A
authors.initials: A
authors.lastname: Govil
authors.forename: G
authors.initials: G
authors.lastname: Mogilishetty
authors.forename: R R
authors.initials: RR
authors.lastname: Alloway
authors.forename: D
authors.initials: D
authors.lastname: Hanseman
authors.forename: M
authors.initials: M
authors.lastname: Cardi
authors.forename: T S
authors.initials: TS
authors.lastname: Diwan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D016030:Kidney Transplantation / Q000592:standards*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications* / Q000601:surgery; D057234:Preoperative Period; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000150:complications* / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
keywords: clinical research/practice; dialysis; endocrinology/diabetology; kidney disease: metabolic; kidney transplantation/nephrology; kidney transplantation: living donor; metabolic syndrome; obesity; organ transplantation in general