title: Is bariatric surgery in patients following renal transplantation safe and effective? A best evidence topic.
abstract: Obesity is common amongst patients with renal transplants (RT). It is associated not only with generic obesity-related complications including diabetes, but also with higher rates of graft rejection and loss. A Best Evidence Topic in surgery was written according to a structured protocol: this is a systematic review of the literature, suitable when the quality of available evidence is low. The question addressed was: is weight-loss surgery (WLS) safe and effective in patients that have had a previous renal transplant? Three prospective case series and one multicentre retrospective study were identified, together reporting on a total of 112 patients who underwent WLS after RT. Eighty-seven patients underwent open WLS and 25 patients underwent laparoscopic operations of which 11 had sleeve gastrectomy and 14 RYGB. Percentage excess weight loss was highly variable between the studies, ranging from an average of 30.8%-75% at 12 months. One graft rejection occurred within 30 days of surgery. All studies were limited by lack of suitable comparison group, short follow-up and heterogeneity in type of bariatric procedure and approach. To date, there is limited evidence to suggest that bariatric surgery is safe and has good short-term outcomes for selected obese patients post-renal transplant.
authors.affiliation: Department of Upper GI Surgery, St. George's University Hospital, NHS Foundation Trust, United Kingdom. Electronic address: nancy.hadjievangelou@gmail.com.
authors.forename: Nancy
authors.initials: N
authors.lastname: Hadjievangelou
authors.affiliation: Department of Upper GI Surgery, St. George's University Hospital, NHS Foundation Trust, United Kingdom.
authors.forename: Myutan
authors.initials: M
authors.lastname: Kulendran
authors.affiliation: Department of Upper GI Surgery, St. George's University Hospital, NHS Foundation Trust, United Kingdom.
authors.forename: Emma Rose
authors.initials: ER
authors.lastname: McGlone
authors.affiliation: Department of Upper GI Surgery, St. George's University Hospital, NHS Foundation Trust, United Kingdom.
authors.forename: Marcus
authors.initials: M
authors.lastname: Reddy
authors.affiliation: Department of Upper GI Surgery, St. George's University Hospital, NHS Foundation Trust, United Kingdom.
authors.forename: Omar A
authors.initials: OA
authors.lastname: Khan
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects / Q000379:methods; D005260:Female; D005743:Gastrectomy / Q000379:methods; D006084:Graft Rejection; D006801:Humans; D016030:Kidney Transplantation; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D009767:Obesity, Morbid / Q000601:surgery; D015431:Weight Loss
keywords: Bariatric surgery; Body mass index; Gastric bypass; Laparoscopic sleeve gastrectomy; Obesity; Post-kidney transplantation; Post-renal transplantation