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Sleeve Gastrectomy Compared with Gastric Bypass for Morbidly Obese Patients with End Stage Renal Disease: a Decision Analysis

  • Rashikh A. ChoudhuryEmail author
  • Gerard Hoeltzel
  • Kas Prins
  • Eric Chow
  • Hunter B. Moore
  • Peter J. Lawson
  • Dor Yoeli
  • Akshay Pratap
  • Peter L. Abt
  • Kristoffel R. Dumon
  • Kendra D. Conzen
  • Trevor L. Nydam
Original Article
  • 57 Downloads

Abstract

Introduction

The use of bariatric surgery has increased for morbidly obese patients with end stage renal disease (ESRD) for whom listing on the waitlist is often restricted until a certain BMI threshold is achieved. Effective weight loss for this population improves access to life-saving renal transplantation. However, it is unclear whether sleeve gastrectomy (SG) vs Roux-en-Y gastric bypass (RYGB) is a more effective therapy for these patients.

Methods

A decision analytic Markov state transition model was created to simulate the life of morbidly obese patients with ESRD who were deemed ineligible to be waitlisted for renal transplantation unless they achieved a BMI less than 35 kg/m2. Life expectancy following weight management (MWM), RYGB, and SG were estimated. Base case patients were defined as having a pre-intervention BMI of 45 kg/m2. Sensitivity analysis of initial BMI was performed. Markov parameters were extracted from literature review.

Results

RYGB improved survival compared with SG and MWM. RYGB patients had higher rates of transplantation, leading to improved mean long-term survival. Base case patients who underwent RYGB gained 1.3 additional years of life compared with patient’s who underwent SG and 2.6 additional years of life compared with MWM.

Conclusions

RYGB improves access to renal transplantation and thereby increases long-term survival compared with SG and MWM. The use of SG may be incongruent with the goal of improving access to renal transplantation for morbidly obese patients.

Keywords

Bariatric surgery Kidney transplantation Markov Decision analysis 

Notes

Author Contributions

Co-authors involved with each segment of manuscript listed below each requirement. All co-authors listed contributed/agree to below requirements:

- Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work: Rashikh A Choudhury MD, Gerard Hoeltzel BS, Kas Prins BSc, Eric Chow MSc, Hunter B Moore MD PhD, Peter J Lawson BS, Dor Yoeli MD, Akshay Chauhan MD, Peter L Abt MD, Kristoffel R Dumon MD, Kendra D Conzen MD, Trevor L Nydam MD.

- Drafting the work or revising it critically for important intellectual content: Rashikh A Choudhury MD, Gerard Hoeltzel BS, Kas Prins BSc, Eric Chow MSc, Hunter B Moore MD PhD, Peter J Lawson BS, Dor Yoeli MD, Akshay Chauhan MD, Peter L Abt MD, Kristoffel R Dumon MD, Kendra D Conzen MD, Trevor L Nydam MD.

- Final approval of the version to be published: Rashikh A Choudhury MD, Gerard Hoeltzel BS, Kas Prins BSc, Eric Chow MSc, Hunter B Moore MD PhD, Peter J Lawson BS, Dor Yoeli MD, Akshay Chauhan MD, Peter L Abt MD, Kristoffel R Dumon MD, Kendra D Conzen MD, Trevor L Nydam MD.

- Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: Rashikh A Choudhury MD, Gerard Hoeltzel BS, Kas Prins BSc, Eric Chow MSc, Hunter B Moore MD PhD, Peter J Lawson BS, Dor Yoeli MD, Akshay Chauhan MD, Peter L Abt MD, Kristoffel R Dumon MD, Kendra D Conzen MD, Trevor L Nydam MD.

-Review of reviewers’ comments, suggestions for improvement, review of the revised manuscript: Rashikh A Choudhury MD, Gerard Hoeltzel BS, Kas Prins BSc, Eric Chow MSc, Hunter B Moore MD PhD, Peter J Lawson BS, Dor Yoeli MD, Akshay Chauhan MD, Peter L Abt MD, Kristoffel R Dumon MD, Kendra D Conzen MD, Trevor L Nydam MD.

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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  • Rashikh A. Choudhury
    • 1
    Email author
  • Gerard Hoeltzel
    • 2
  • Kas Prins
    • 1
  • Eric Chow
    • 3
  • Hunter B. Moore
    • 1
  • Peter J. Lawson
    • 1
  • Dor Yoeli
    • 1
  • Akshay Pratap
    • 4
  • Peter L. Abt
    • 2
  • Kristoffel R. Dumon
    • 2
  • Kendra D. Conzen
    • 1
  • Trevor L. Nydam
    • 1
  1. 1.Department of Surgery, Division of Transplant SurgeryUniversity of Colorado HospitalAuroraUSA
  2. 2.Department of SurgeryHospital of the University of PennsylvaniaPhiladelphiaUSA
  3. 3.Department of Medicine- Quantitative Sciences UnitStanford University Medical CenterPalo AltoUSA
  4. 4.Department Surgery, Division of MIS/Bariatric SurgeryUniversity of Colorado HospitalAuroraUSA

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