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Obesity Surgery

, Volume 29, Issue 2, pp 713–720 | Cite as

Efficacy and Safety of Intra-gastric Balloon Placement in Dialyzed Patients Awaiting Kidney Transplantation

  • Séverine BeaudreuilEmail author
  • Franck Iglicki
  • Séverine Ledoux
  • Michelle Elias
  • Erika NNang Obada
  • Hadia Hebibi
  • Emmanuel Durand
  • Bernard Charpentier
  • Benoit Coffin
  • Antoine Durrbach
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Abstract

Background

The number of obese patients who are candidates for renal transplantation has considerably increased, but obesity can be a barrier to kidney transplantation. Weight loss is often difficult through diet alone. We studied the efficacy and tolerance of the intra-gastric balloon (IGB) procedure in obese patients who were undergoing dialysis and were candidates for a renal transplantation.

Patients and Methods

Obese patients (BMI > 30 kg/m2) who were candidates for renal transplantation were prospectively included in the study between 2010 and 2012. The balloon was inserted and removed during a gastric endoscopy under general anesthesia. The treatment lasted 6 months. The end point was a decrease in BMI after 6 months. Body impedance spectrometry (BIS) and nutritional statute were evaluated initially and then after IGB removal.

Results

Seventeen patients (nine females and eight males) with a mean age of 53.4 years [19.4–69.4] were included. The decrease in body mass index (BMI) during the 6-month placement was 3 kg/m2 (from 37.7 to 34.4 kg/m2). The mean weight loss was 7 kg. The mean percentage of excess weight loss after 6 months was 20.2 (± 11.4). The tolerance was good without any complications. Eleven patients underwent kidney transplantation.

Conclusion

IGB in obese dialyzed patients who are candidates for renal transplantation is safe and effective. However, the amount of weight loss can vary.

Keywords

Obesity Intra-gastric balloon Awaiting kidney transplantation Hemodialysis Efficacy Safety 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Statement of Informed Consent

Informed consent was obtained from all individual participants included in the study.

Statement of Human Rights

The study was conducted in accordance with human rights.

References

  1. 1.
    Wolfe RA, Ashby VB, Milford EL, et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med. 1999;341:1725–30.CrossRefGoogle Scholar
  2. 2.
    Kovacs AZ, Molnar MZ, Szeifert L, et al. Sleep disorders, depressive symptoms and health-related quality of life--a cross-sectional comparison between kidney transplant recipients and waitlisted patients on maintenance dialysis. Nephrol Dial Transplant. 2011;26:1058–65.CrossRefGoogle Scholar
  3. 3.
    Gill JS, Rose C, Pereira BJ, et al. The importance of transitions between dialysis and transplantation in the care of end-stage renal disease patients. Kidney Int. 2007;71:442–7.CrossRefGoogle Scholar
  4. 4.
    Stevens J, Cai J, Pamuk ER, et al. The effect of age on the association between body-mass index and mortality. N Engl J Med. 1998;338:1–7.CrossRefGoogle Scholar
  5. 5.
    Kalantar-Zadeh K, Kuwae N, Wu DY, et al. Associations of body fat and its changes over time with quality of life and prospective mortality in hemodialysis patients. Am J Clin Nutr. 2006;83:202–10.CrossRefGoogle Scholar
  6. 6.
    Kopple JD, Zhu X, Lew NL, et al. Body weight-for-height relationships predict mortality in maintenance hemodialysis patients. Kidney Int. 1999;56:1136–48.CrossRefGoogle Scholar
  7. 7.
    Leavey SF, McCullough K, Hecking E, et al. Body mass index and mortality in ‘healthier’ as compared with ‘sicker’ haemodialysis patients: results from the dialysis outcomes and practice patterns study (DOPPS). Nephrol Dial Transplant. 2001;16:2386–94.CrossRefGoogle Scholar
  8. 8.
    Postorino M, Marino C, Tripepi G, et al. Abdominal obesity and all-cause and cardiovascular mortality in end-stage renal disease. J Am Coll Cardiol. 2009;53:1265–72.CrossRefGoogle Scholar
  9. 9.
    Scandling JD. Kidney transplant candidate evaluation. Semin Dial. 2005;18:487–94.CrossRefGoogle Scholar
  10. 10.
    Holley JL, Monaghan J, Byer B, et al. An examination of the renal transplant evaluation process focusing on cost and the reasons for patient exclusion. Am J Kidney Dis. 1998;32:567–74.CrossRefGoogle Scholar
  11. 11.
    Schwarznau A, Matevossian E, Novotny A, et al. Outcome of living donor renal transplantation in obese recipients. Transplant Proc. 2008;40:921–2.CrossRefGoogle Scholar
  12. 12.
    Grosso G, Corona D, Mistretta A, et al. The role of obesity in kidney transplantation outcome. Transplant Proc. 2012;44:1864–8.CrossRefGoogle Scholar
  13. 13.
    Mehta R, Shah G, Leggat JE, et al. Impact of recipient obesity on living donor kidney transplant outcomes: a single-center experience. Transplant Proc. 2007;39:1421–3.CrossRefGoogle Scholar
  14. 14.
    Singh D, Lawen J, Alkhudair W. Does pretransplant obesity affect the outcome in kidney transplant recipients? Transplant Proc. 2005;37:717–20.CrossRefGoogle Scholar
  15. 15.
    Bardonnaud N, Pillot P, Lillaz J, et al. Outcomes of renal transplantation in obese recipients. Transplant Proc. 2012;44:2787–91.CrossRefGoogle Scholar
  16. 16.
    Furriel F, Parada B, Campos L, et al. Pretransplantation overweight and obesity: does it really affect kidney transplantation outcomes? Transplant Proc. 2011;43:95–9.CrossRefGoogle Scholar
  17. 17.
    Behzadi AH, Kamali K, Zargar M, et al. Obesity and urologic complications after renal transplantation. Saudi J Kidney Dis Transpl. 25:303–8.Google Scholar
  18. 18.
    Johnson DW, Isbel NM, Brown AM, et al. The effect of obesity on renal transplant outcomes. Transplantation. 2002;74:675–81.CrossRefGoogle Scholar
  19. 19.
    Molnar MZ, Kovesdy CP, Mucsi I, et al. Higher recipient body mass index is associated with post-transplant delayed kidney graft function. Kidney Int. 2011;80:218–24.CrossRefGoogle Scholar
  20. 20.
    Gusukuma LW, Harada KM, Baptista AP, et al. Outcomes in obese kidney transplant recipients. Transplant Proc. 2014;46:3416–9.CrossRefGoogle Scholar
  21. 21.
    Lentine KL, Rocca-Rey LA, Bacchi G, et al. Obesity and cardiac risk after kidney transplantation: experience at one center and comprehensive literature review. Transplantation. 2008;86:303–12.CrossRefGoogle Scholar
  22. 22.
    Takata MC, Campos GM, Ciovica R, et al. Laparoscopic bariatric surgery improves candidacy in morbidly obese patients awaiting transplantation. Surg Obes Relat Dis. 2008;4:159–64. discussion 164-155CrossRefGoogle Scholar
  23. 23.
    Lin MY, Tavakol MM, Sarin A, et al. Laparoscopic sleeve gastrectomy is safe and efficacious for pretransplant candidates. Surg Obes Relat Dis. 2013;9:653–8.CrossRefGoogle Scholar
  24. 24.
    Turgeon NA, Perez S, Mondestin M, et al. The impact of renal function on outcomes of bariatric surgery. J Am Soc Nephrol. 2012;23:885–94.CrossRefGoogle Scholar
  25. 25.
    Imaz I, Martinez-Cervell C, Garcia-Alvarez EE, et al. Safety and effectiveness of the intragastric balloon for obesity. A meta-analysis. Obes Surg. 2008;18:841–6.CrossRefGoogle Scholar
  26. 26.
    Genco A, Maselli R, Frangella F, et al. Intragastric balloon for obesity treatment: results of a multicentric evaluation for balloons left in place for more than 6 months. Surg Endosc. 29:2339–43.Google Scholar
  27. 27.
    Roman S, Napoleon B, Mion F, et al. Intragastric balloon for “non-morbid” obesity: a retrospective evaluation of tolerance and efficacy. Obes Surg. 2004;14:539–44.CrossRefGoogle Scholar
  28. 28.
    Al-Momen A, El-Mogy I. Intragastric balloon for obesity: a retrospective evaluation of tolerance and efficacy. Obes Surg. 2005;15:101–5.CrossRefGoogle Scholar
  29. 29.
    MacLaughlin HL, Macdougall IC, Hall WL, et al. Does intragastric balloon treatment for obesity in chronic kidney disease heighten acute kidney injury risk? Am J Nephrol. 2016;44:411–8.CrossRefGoogle Scholar
  30. 30.
    Chouillard EK, Karaa A, Elkhoury M, et al. Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for morbid obesity: case-control study. Surg Obes Relat Dis. 2011;7:500–5.CrossRefGoogle Scholar
  31. 31.
    Gehrer S, Kern B, Peters T, et al. Fewer nutrient deficiencies after laparoscopic sleeve gastrectomy (LSG) than after laparoscopic roux-y-gastric bypass (LRYGB)—a prospective study. Obes Surg. 2010;20:447–53.CrossRefGoogle Scholar
  32. 32.
    Cook SA, MacLaughlin H, Macdougall IC. A structured weight management programme can achieve improved functional ability and significant weight loss in obese patients with chronic kidney disease. Nephrol Dial Transplant. 2008;23:263–8.CrossRefGoogle Scholar
  33. 33.
    Kuo JH, Wong MS, Perez RV, et al. Renal transplant wound complications in the modern era of obesity. J Surg Res. 2012;173:216–23.CrossRefGoogle Scholar
  34. 34.
    Molnar MZ, Streja E, Kovesdy CP, et al. Associations of body mass index and weight loss with mortality in transplant-waitlisted maintenance hemodialysis patients. Am J Transplant. 2011;11:725–36.CrossRefGoogle Scholar
  35. 35.
    Schold JD, Srinivas TR, Guerra G, et al. A “weight-listing” paradox for candidates of renal transplantation? Am J Transplant. 2007;7:550–9.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Séverine Beaudreuil
    • 1
    • 2
    Email author
  • Franck Iglicki
    • 3
  • Séverine Ledoux
    • 4
  • Michelle Elias
    • 1
  • Erika NNang Obada
    • 1
  • Hadia Hebibi
    • 1
  • Emmanuel Durand
    • 5
  • Bernard Charpentier
    • 1
    • 2
  • Benoit Coffin
    • 3
  • Antoine Durrbach
    • 1
    • 2
  1. 1.Department of Nephrology Dialysis, Transplantation, IFRNTUniversity of Paris-SudLe Kremlin BicetreFrance
  2. 2.INSERM UMRS1197VillejuifFrance
  3. 3.Gastroenterology Unit, AP-HPLouis Mourier Hospital and Denis Diderot University Paris 7ParisFrance
  4. 4.Service des Explorations Fonctionnelles and Centre Intégré Nord Francilien de prise en charge de l’Obésité (CINFO)Hôpital Louis Mourier (AP-HP) and Université Paris DiderotParisFrance
  5. 5.IR4M (UMR8081), 91405 Univ Paris Sud, Univ Paris Saclay, Department of Nuclear MedicineHôpitaux Universitaires Paris SudParisFrance

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