title: Laparoscopic sleeve gastrectomy: gateway to kidney transplantation.
abstract: BACKGROUND
  The prevalence of obesity and obesity-related morbidity in end-stage renal disease patients is rising. Although it is established that obesity does not abrogate the transplant benefit with respect to lower long-term mortality and cardiovascular risk, it is associated with increased graft failure, delayed graft function, surgical complications, prolonged hospital stay, and costs.
  
  
  OBJECTIVE
  To examine the safety and efficacy of LSG (laparoscopic sleeve gastrectomy) in renal transplant candidates and evaluate transplant outcomes.
  
  
  METHODS
  Single-center prospective nonrandomized trial METHODS: We here report on a prospective single-center trial establishing a 2-step approach for obese renal transplant candidates. Patients with end-stage renal disease and a BMI (body mass index) of 35 kg/m2or higher underwent laparoscopic sleeve gastrectomy. After reaching a BMI of<35 kg/m2, patients were waitlisted for kidney transplantation. Age, gender, body mass index (BMI), associated co-morbidities, cause of end-stage renal disease, surgical complications, and outcome after kidney transplantation (graft survival, incidence of delayed graft function, incidence of rejection, serum creatinine) were collected.
  
  
  RESULTS
  LSG was performed in 8 renal transplant candidates with a mean BMI of 38.8 kg/m2each. BMI dropped to below 35 kg/m2within a median of 3 months. Percent excess body mass index loss (%EBMIL) was 62.7% at 1 year after LSG. Within 17 months (mean) after metabolic surgery, 7 patients underwent kidney transplantation. All transplants were successful with a serum creatinine of 1.9±.8 mg/dL at discharge and stable allograft function thereafter. Mean follow-up was 3.2±1.4 years; no patient was lost to follow-up.
  
  
  CONCLUSIONS
  LSG is safe and efficacious for treatment of obesity in renal transplant candidates. Rapid and sustained weight loss and subsequent waitlisting for kidney transplantation may reduce overall and in particular posttransplant patient morbidity.
authors.affiliation: Department of Visceral, Transplant, and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Katrin
authors.initials: K
authors.lastname: Kienzl-Wagner
authors.affiliation: Department of Visceral, Transplant, and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Annemarie
authors.initials: A
authors.lastname: Weissenbacher
authors.affiliation: Department of Visceral, Transplant, and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Philipp
authors.initials: P
authors.lastname: Gehwolf
authors.affiliation: Department of Visceral, Transplant, and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Heinz
authors.initials: H
authors.lastname: Wykypiel
authors.affiliation: Department of Visceral, Transplant, and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Dietmar
authors.initials: D
authors.lastname: Öfner
authors.affiliation: Department of Visceral, Transplant, and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria. Electronic address: stefan.schneeberger@i-med.ac.at.
authors.forename: Stefan
authors.initials: S
authors.lastname: Schneeberger
mesh_terms: D000328:Adult; D064591:Allografts / Q000503:physiopathology; D050110:Bariatric Surgery / Q000009:adverse effects / Q000379:methods*; D015992:Body Mass Index; D051799:Delayed Graft Function / Q000503:physiopathology; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D006084:Graft Rejection / Q000503:physiopathology; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D016030:Kidney Transplantation; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: Bariatric surgery; Dialysis; End-stage renal disease; Kidney transplantation; Metabolic surgery; Sleeve gastrectomy; Transplantation