Bariatric Surgery After Kidney TransplantsTuesday, September 29, 2009
Although most of my practice today is bariatric medicine, as a trained nephrologist, I continue to keep an eye on the nephrology literature. I was therefore interested to note this recent study on the outcomes and safety of bariatric surgery in patients who underwent kidney transplants.
As blogged before, obesity is a significant risk factor for progression of renal failure (not surprising as obesity is a common cause of both hypertension and type 2 diabetes), but obesity also often develops in transplant recipients due to some of the immunosuppressive and other medications that these patients may have to be on.
It is therefore not at all surprising that many transplant recipients have (or develop) severe obesity that may warrant consideration for bariatric surgery, which continues to be the only evidence-based treatment for severe obesity.
In this paper published in the latest issue of OBESITY SURGERY, Samuel Szomstein and colleagues from the Cleveland Clinic Florida, USA, performed a retrospective chart review of prospectively collected data on five severely obese women (age 30-48; BMI 48-69) after kidney transplantation who underwent laparoscopic bariatric surgery. All patients were females, with a mean age of 40.8 years (range 30-48) and mean body mass index (BMI) of 52.2 (range 48-69). Four patients had laparoscopic Roux-en-Y gastric bypass and one had laparoscopic sleeve gastrectomy.
Patient lost an average of 50% of their excess weight at two years post surgery (around the same as in non-transplant patients) and there were no postoperative complications in any patients.
Immunosupressive therapy was unaltered after surgery.
Although this paper certainly suggests that bariatric surgery can safely be performed in kidney transplant recipients, the rather short two-year follow-up period and the small number of patients certainly does not allow hard conclusions regarding wether or not bariatric surgery will indeed improve life of the transplant and patients.
For now, I believe that the decision to perform bariatric patients on recipients of kidney or other transplants will likely remain a case-by-case decision at experienced centres.