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Bariatric Surgery as a Bridge to Facilitate Renal Transplantation in Patients with End-Stage Renal Disease

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Abstract

Purpose

Renal transplantation (RT) is not recommended above BMI 40 kg/m2 as post-operative risks (delayed graft function, wound complications) are increased. Bariatric surgery (BS) results in sustained long-term weight loss. However, renal failure (RF) patients are theoretically higher risk candidates. We aim to investigate the safety of BS in patients with RF and the effect of BS on access to renal transplantation.

Methods

We reviewed data from 31 patients with RF referred for BS between 2013 and 2021. We compared the outcomes of patients with RF who underwent BS to those who were referred but did not undergo BS. Controls matched for age/BMI/comorbidity (MC) but without RF were used for comparison.

Results

Of 31 patients referred, 19 proceeded with BS (68% female, median age 52 years, BMI 46.2 ± 4.9 kg/m2) and 12 did not (58% female, median age 58, mean BMI 41.5 ± 4.1). Excess body weight loss (EBWL) was 71.2% ± 20.2% at 2 years in RF patients versus 66.0% ± 28.0% in MC patients. In the operated group, 11/19 (58%) patients reached their treatment target (six transplanted, five placed on waiting list) versus 3/12 (25%) in unoperated patients (three transplanted). There was no difference in perioperative complications between RF and MC groups. Long-term, there were seven deaths amongst RF patients (two operated, five unoperated), none amongst the MC group.

Conclusion

BS in patients with RF increased access to RT and was safe and effective. We therefore recommend consideration of BS in patients with obesity and RF in specialised units.

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Authors and Affiliations

  1. Department of Bariatric Surgery, Whittington Health NHS Trust, London, N19 5NF, UK

    Karen D. Bosch, Liene Sulutaura, Emilane Lacea, Katarina Burton, Naiara Fernandez-Munoz & Pratik Sufi

  2. Department of Surgery, Royal London Hospital, Barts Health NHS Trust, London, E1 1FR, UK

    Cuan Harrington

  3. National Kidney Transplant Service, Beaumont Hospital, Dublin, D09V2N0, Ireland

    Neal Dugal

  4. Department of Renal Transplantation, Royal Free Hospitals NHS Foundation Trust, London, NW3 2QG, UK

    Ammar Al Midani

  5. Department of Surgery, Whittington Hospital, London, N19 5NF, UK

    Chetan Parmar

  6. University College London, London, WC1E 6BT, UK

    Chetan Parmar

Authors
  1. Karen D. Bosch
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  2. Cuan Harrington
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  3. Liene Sulutaura
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  4. Emilane Lacea
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  7. Neal Dugal
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  10. Chetan Parmar
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Corresponding author

Correspondence to Karen D. Bosch.

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This study has local institutional approval (2022/23–86).

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Key Points

• Obesity is a barrier to renal transplantation and associated with poorer post-operative outcomes.

• We show that bariatric surgery is effective and safe in a cohort of renal failure patients, with evidence of improvement in comorbidities.

• Through collaboration between renal and bariatric surgery units, access to renal transplantation is increased and survival may be improved in patients suspended from the waiting list due to obesity.

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Bosch, K.D., Harrington, C., Sulutaura, L. et al. Bariatric Surgery as a Bridge to Facilitate Renal Transplantation in Patients with End-Stage Renal Disease. OBES SURG 34, 355–362 (2024). https://doi.org/10.1007/s11695-023-06985-6

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  • DOI: https://doi.org/10.1007/s11695-023-06985-6

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