Abstract | April 4, 2022
A Promising Combination: Bariatric Surgery prior to Kidney Transplantation for Obese ESRD Patients
- Pre-KT bariatric surgery offers reduction of pre-KT comorbidities, allows for successful transplant, and offers improved compliance.
Introduction: Obese patients with ESRD have limited access and higher complication rate during kidney transplantation (KT). We report outcomes when screening obese patients with ESRD to undergo bariatric surgery prior to KT.
Methods: We performed a two-year prospective analysis of obese KT candidates (BMI >35 and GFR <20) who received bariatric surgery and subsequent KT. We evaluated their pre- and post-bariatric demographics and post-KT variables with monthly follow-up visits.
Results: A total of 81 patients were enrolled, of which 74% had pre-existing hypertension and 51% had diabetes (Table 1). Eighteen patients have undergone bariatric surgery to date and four patients have received subsequent KT. Patients had an average timeline from initial transplant screening to bariatric consultation of 28 days, to bariatric surgery of 127 days, to waitlist placement of 323 days, and to KT of 230 days (Figure 1). In all enrolled patients, average BMI decreased by 16 between the initial bariatric consultation and KT; notably, none regained weight at 6 month follow up (Table 2). Interestingly, 25% of patients developed hypotension (systolic blood pressure <100) after vertical sleeve gastrectomy and 55% of them required pro-hypertensive medications.
Conclusions: Bariatric surgery offers a promising option for KT candidates who may be predisposed to worse outcomes due to obesity. Pre-KT bariatric surgery offers reduction of pre-KT comorbidities, allows for successful transplant, and offers improved compliance. The issue of hypotension post-bariatric surgery is relatively novel in ESRD patients.