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Safety and efficacy of the sleeve gastrectomy as a strategy towards kidney transplantation

  • 2019 SAGES Oral
  • Published:
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Abstract

Background

Obese individuals suffering from advanced chronic kidney disease (CKD) may be precluded from accessing kidney transplantation. Bariatric surgery is an effective treatment for obesity and related conditions but its use in those with severe CKD remains limited due to morbidity concerns. We aimed to evaluate the safety and efficacy of sleeve gastrectomy (SG) in patients with severe CKD as a bridging strategy towards kidney transplant candidacy.

Methods

This is a single-center retrospective study of a prospectively collected database of obese patients referred by the multi-organ transplant team for surgical weight loss, who underwent SG during 2013–2018. The primary outcome was 90-day major morbidity. Secondary outcomes included weight loss, and successful kidney transplantation. Descriptive statistics are expressed as count (percent) or median (interquartile range).

Results

32 patients met inclusion criteria. 18 (56%) were male with a median age and BMI of 51 (11) years and 42.3 (5.2) kg/m2, respectively. 29 (91%) patients were on dialysis for a median duration of 28 months before SG. Diabetes, hypertension, and dyslipidemia were present in 15 (47%), 25 (78%), and 21 (66%) patients, respectively. At 90 days after SG, there were no leaks, reoperations, or mortality. The median length of stay was 2 (1.3) days. At 1 year, change in BMI and percent excess weight loss (EWL) were −9.8 (3.7) kg/m2 and 56% (27), respectively. In the year after SG, 20 (63%) patients were listed for transplant. 14 (44%) underwent successful kidney transplantation. One patient died while waiting for transplant. At time of transplant, median change in BMI and EWL were −9.0 (5.5) kg/m2 and 59% (30), respectively. After transplant, no patient required dialysis at a median follow-up of 17 (32) months.

Conclusion

SG is safe and effective for weight loss and bridging to candidacy for kidney transplantation in patients with severe CKD. The acceptable safety and efficiency of SG in this high-risk population makes it an optimal choice as a bridging procedure.

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References

  1. Kjøllesdal MKR, Smith GD, Ariansen I, Kinge JM, Degerud E, Næss Ø (2018) The association between BMI and mortality using early adulthood BMI as an instrumental variable for midlife BMI. Sci Rep 8:11499

    Article  Google Scholar 

  2. Collaborators GBDO, Afshin A, Forouzanfar MH, Reitsma MB, Sur P, Estep K, Lee A, Marczak L, Mokdad AH, Moradi-Lakeh M, Naghavi M, Salama JS, Vos T, Abate KH, Abbafati C, Ahmed MB, Al-Aly Z, Alkerwi A, Al-Raddadi R, Amare AT, Amberbir A, Amegah AK, Amini E, Amrock SM, Anjana RM, Arnlov J, Asayesh H, Banerjee A, Barac A, Baye E, Bennett DA, Beyene AS, Biadgilign S, Biryukov S, Bjertness E, Boneya DJ, Campos-Nonato I, Carrero JJ, Cecilio P, Cercy K, Ciobanu LG, Cornaby L, Damtew SA, Dandona L, Dandona R, Dharmaratne SD, Duncan BB, Eshrati B, Esteghamati A, Feigin VL, Fernandes JC, Furst T, Gebrehiwot TT, Gold A, Gona PN, Goto A, Habtewold TD, Hadush KT, Hafezi-Nejad N, Hay SI, Horino M, Islami F, Kamal R, Kasaeian A, Katikireddi SV, Kengne AP, Kesavachandran CN, Khader YS, Khang YH, Khubchandani J, Kim D, Kim YJ, Kinfu Y, Kosen S, Ku T, Defo BK, Kumar GA, Larson HJ, Leinsalu M, Liang X, Lim SS, Liu P, Lopez AD, Lozano R, Majeed A, Malekzadeh R, Malta DC, Mazidi M, McAlinden C, McGarvey ST, Mengistu DT, Mensah GA, Mensink GBM, Mezgebe HB, Mirrakhimov EM, Mueller UO, Noubiap JJ, Obermeyer CM, Ogbo FA, Owolabi MO, Patton GC, Pourmalek F, Qorbani M, Rafay A, Rai RK, Ranabhat CL, Reinig N, Safiri S, Salomon JA, Sanabria JR, Santos IS, Sartorius B, Sawhney M, Schmidhuber J, Schutte AE, Schmidt MI, Sepanlou SG, Shamsizadeh M, Sheikhbahaei S, Shin MJ, Shiri R, Shiue I, Roba HS, Silva DAS, Silverberg JI, Singh JA, Stranges S, Swaminathan S, Tabares-Seisdedos R, Tadese F, Tedla BA, Tegegne BS, Terkawi AS, Thakur JS, Tonelli M, Topor-Madry R, Tyrovolas S, Ukwaja KN, Uthman OA, Vaezghasemi M, Vasankari T, Vlassov VV, Vollset SE, Weiderpass E, Werdecker A, Wesana J, Westerman R, Yano Y, Yonemoto N, Yonga G, Zaidi Z, Zenebe ZM, Zipkin B, Murray CJL (2017) Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med 377:13–27

    Article  Google Scholar 

  3. Hales CM, Carroll MD, Fryar CD, Ogden CL (2017) Prevalence of obesity among adults and youth: United States, 2015–2016. NCHS Data Brief:1–8

  4. Saran R, Robinson B, Abbott KC, Agodoa LYC, Bragg-Gresham J, Balkrishnan R, Bhave N, Dietrich X, Ding Z, Eggers PW, Gaipov A, Gillen D, Gipson D, Gu H, Guro P, Haggerty D, Han Y, He K, Herman W, Heung M, Hirth RA, Hsiung J-T, Hutton D, Inoue A, Jacobsen SJ, Jin Y, Kalantar-Zadeh K, Kapke A, Kleine C-E, Kovesdy CP, Krueter W, Kurtz V, Li Y, Liu S, Marroquin MV, McCullough K, Molnar MZ, Modi Z, Montez-Rath M, Moradi H, Morgenstern H, Mukhopadhyay P, Nallamothu B, Nguyen DV, Norris KC, O’Hare AM, Obi Y, Park C, Pearson J, Pisoni R, Potukuchi PK, Repeck K, Rhee CM, Schaubel DE, Schrager J, Selewski DT, Shamraj R, Shaw SF, Shi JM, Shieu M, Sim JJ, Soohoo M, Steffick D, Streja E, Sumida K, Kurella Tamura M, Tilea A, Turf M, Wang D, Weng W, Woodside KJ, Wyncott A, Xiang J, Xin X, Yin M, You AS, Zhang X, Zhou H, Shahinian V (2019) US renal data system 2018 annual data report: epidemiology of kidney disease in the United States. Am J Kidney Dis 73:A7–A8

    Article  Google Scholar 

  5. Wang Y, Chen X, Song Y, Caballero B, Cheskin LJ (2008) Association between obesity and kidney disease: a systematic review and meta-analysis. Kidney Int 73:19–33

    Article  CAS  Google Scholar 

  6. Tonelli M, Wiebe N, Knoll G, Bello A, Browne S, Jadhav D, Klarenbach S, Gill J (2011) Systematic review: kidney transplantation compared with dialysis in clinically relevant outcomes. Am J Transplant 11:2093–2109

    Article  CAS  Google Scholar 

  7. Hill CJ, Courtney AE, Cardwell CR, Maxwell AP, Lucarelli G, Veroux M, Furriel F, Cannon RM, Hoogeveen EK, Doshi M, McCaughan JA (2015) Recipient obesity and outcomes after kidney transplantation: a systematic review and meta-analysis. Nephrol Dial Transplant 30:1403–1411

    Article  Google Scholar 

  8. Segev DL, Simpkins CE, Thompson RE, Locke JE, Warren DS, Montgomery RA (2008) Obesity impacts access to kidney transplantation. J Am Soc Nephrol 19:349–355

    Article  Google Scholar 

  9. Lassalle M, Fezeu LK, Couchoud C, Hannedouche T, Massy ZA, Czernichow S (2017) Obesity and access to kidney transplantation in patients starting dialysis: a prospective cohort study. PLoS ONE 12:e0176616

    Article  Google Scholar 

  10. Chan G, Soucisse M (2016) Survey of canadian kidney transplant specialists on the management of morbid obesity and the transplant waiting list. Can J Kidney Health Dis 3:2054358116675344

    Article  Google Scholar 

  11. Mehra, Canter CE, Hannan MM, Semigran MJ, Uber PA, Baran DA, Danziger-Isakov L, Kirklin JK, Kirk R, Kushwaha SS, Lund LH, Potena L, Ross HJ, Taylor DO, Verschuuren EA, Zuckermann A, International Society for Heart Lung Transplantation Infectious Diseases C, International Society for Heart Lung Transplantation Pediatric Transplantation C, International Society for Heart Lung Transplantation Heart F, Transplantation C (2016) The 2016 International Society for Heart Lung Transplantation listing criteria for heart transplantation: a 10-year update. J Heart Lung Transpl 35:1–23

    Article  Google Scholar 

  12. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292:1724–1737

    Article  CAS  Google Scholar 

  13. Schauer PR, Bhatt DL, Kirwan JP, Wolski K, Aminian A, Brethauer SA, Navaneethan SD, Singh RP, Pothier CE, Nissen SE, Kashyap SR, Investigators S (2017) Bariatric surgery versus intensive medical therapy for diabetes—5-year outcomes. N Engl J Med 376:641–651

    Article  Google Scholar 

  14. McLawhorn AS, Levack AE, Lee YY, Ge Y, Do H, Dodwell ER (2018) Bariatric surgery improves outcomes after lower extremity arthroplasty in the morbidly obese: a propensity score-matched analysis of a New York statewide database. J Arthroplast 33(2062–2069):e2064

    Google Scholar 

  15. Schwarzkopf R, Lavery JA, Hooper J, Parikh M, Gold HT (2018) Bariatric surgery and time to total joint arthroplasty: does it affect readmission and complication rates? Obes Surg 28:1395–1401

    Article  Google Scholar 

  16. Menzo EL, Hinojosa M, Carbonell A, Krpata D, Carter J, Rogers AM (2018) American society for metabolic and bariatric surgery and American hernia society consensus guideline on bariatric surgery and hernia surgery. Surg Obes Relat Dis 14:1221–1232

    Article  Google Scholar 

  17. Brethauer SA, Kim J, el Chaar M, Papasavas P, Eisenberg D, Rogers A, Ballem N, Kligman M, Kothari S (2015) Standardized outcomes reporting in metabolic and bariatric surgery. Surg Obes Relat Dis 11:489–506

    Article  Google Scholar 

  18. Dziodzio T, Biebl M, Ollinger R, Pratschke J, Denecke C (2017) The role of bariatric surgery in abdominal organ transplantation-the next big challenge? Obes Surg 27:2696–2706

    Article  Google Scholar 

  19. Modanlou KA, Muthyala U, Xiao H, Schnitzler MA, Salvalaggio PR, Brennan DC, Abbott KC, Graff RJ, Lentine KL (2009) Bariatric surgery among kidney transplant candidates and recipients: analysis of the United States renal data system and literature review. Transplantation 87:1167–1173

    Article  Google Scholar 

  20. Freeman CM, Woodle ES, Shi J, Alexander JW, Leggett PL, Shah SA, Paterno F, Cuffy MC, Govil A, Mogilishetty G, Alloway RR, Hanseman D, Cardi M, Diwan TS (2015) Addressing morbid obesity as a barrier to renal transplantation with laparoscopic sleeve gastrectomy. Am J Transplant 15:1360–1368

    Article  CAS  Google Scholar 

  21. Kumar SB, Hamilton BC, Wood SG, Rogers SJ, Carter JT, Lin MY (2018) Is laparoscopic sleeve gastrectomy safer than laparoscopic gastric bypass? a comparison of 30-day complications using the MBSAQIP data registry. Surg Obes Relat Dis 14:264–269

    Article  Google Scholar 

  22. Andalib A, Aminian A, Khorgami Z, Navaneethan SD, Schauer PR, Brethauer SA (2016) Safety analysis of primary bariatric surgery in patients on chronic dialysis. Surg Endosc 30:2583–2591

    Article  Google Scholar 

  23. Zellmer JD, Mathiason MA, Kallies KJ, Kothari SN (2014) Is laparoscopic sleeve gastrectomy a lower risk bariatric procedure compared with laparoscopic Roux-en-Y gastric bypass? A meta-analysis. Am J Surg 208:903–910

    Article  Google Scholar 

  24. Jamal MH, Corcelles R, Daigle CR, Rogula T, Kroh M, Schauer PR, Brethauer SA (2015) Safety and effectiveness of bariatric surgery in dialysis patients and kidney transplantation candidates. Surg Obes Relat Dis 11:419–423

    Article  Google Scholar 

  25. Schauer DP, Feigelson HS, Koebnick C, Caan B, Weinmann S, Leonard AC, Powers JD, Yenumula PR, Arterburn DE (2019) Bariatric surgery and the risk of cancer in a large multisite cohort. Ann Surg 269:95–101

    Article  Google Scholar 

  26. Ward KK, Roncancio AM, Shah NR, Davis MA, Saenz CC, McHale MT, Plaxe SC (2014) Bariatric surgery decreases the risk of uterine malignancy. Gynecol Oncol 133:63–66

    Article  Google Scholar 

  27. Salminen P, Helmio M, Ovaska J, Juuti A, Leivonen M, Peromaa-Haavisto P, Hurme S, Soinio M, Nuutila P, Victorzon M (2018) Effect of laparoscopic sleeve gastrectomy versus laparoscopic Roux-en-Y gastric bypass on weight loss at 5 years among patients with morbid obesity: the SLEEVEPASS randomized clinical trial. JAMA 319:241–254

    Article  Google Scholar 

  28. Rogers CC, Alloway RR, Alexander JW, Cardi M, Trofe J, Vinks AA (2008) Pharmacokinetics of mycophenolic acid, tacrolimus and sirolimus after gastric bypass surgery in end-stage renal disease and transplant patients: a pilot study. Clin Transpl 22:281–291

    Article  Google Scholar 

  29. Marterre WF, Hariharan S, First MR, Alexander JW (1996) Gastric bypass in morbidly obese kidney transplant recipients. Clin Transpl 10:414–419

    CAS  Google Scholar 

  30. Yemini R, Nesher E, Winkler J, Carmeli I, Azran C, Ben David M, Mor E, Keidar A (2018) Bariatric surgery in solid organ transplant patients: long-term follow-up results of outcome, safety, and effect on immunosuppression. Am J Transpl 18:2772–2780

    Article  Google Scholar 

  31. Haberal M, Boyvat F, Akdur A, Kirnap M, Ozcelik U, Yarbug Karakayali F (2016) Surgical complications after kidney transplantation. Exp Clin Transpl 14:587–595

    Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Center for Bariatric Surgery, McGill University, Montreal General Hospital, 1650 Cedar Avenue, Room: E16-165A, H3G 1A4, Montreal, QC, Canada

    Philippe Bouchard, Sebastian Demyttenaere, Olivier Court & Amin Andalib

  2. Multi-organ Transplant Program, Department of Surgery, McGill University, Montreal, QC, Canada

    Jean Tchervenkov

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  1. Philippe Bouchard
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Correspondence to Amin Andalib.

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Drs. Philippe Bouchard, Jean Tchervenkov, Sebastian Demyttenaere, Olivier Court, and Amin Andalib have no conflicts of interest or financial ties to disclose.

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Bouchard, P., Tchervenkov, J., Demyttenaere, S. et al. Safety and efficacy of the sleeve gastrectomy as a strategy towards kidney transplantation. Surg Endosc 34, 2657–2664 (2020). https://doi.org/10.1007/s00464-019-07042-z

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