Bariatric Surgery as a Bridge for Renal Transplantation. An Age and BMI-Matched Pair Analysis

Abstract

Background: Morbid obesity is a relative contraindication for renal transplantation (RT) and associated with increased perioperative complications and compromised graft survival. We aimed at evaluating the safety of bariatric surgery (BS) in patients with end-stage renal disease (ESRD) and its efficacy on improving access to RT and to compare RT outcomes to an age- and body mass index (BMI)-matched group.

Methods: This is a case-control study including eight patients with ESRD who underwent BS as a bridge before RT (group I). The primary outcome was to assess the safety and efficacy of BS. The secondary outcome was to assess the impact on RT outcomes, surgical complications, and long-term graft survival. The third outcome was to compare them to an age- and BMI-matched control group (group II, 16 patients).

Results: In group I, the median (IQR) BMI decreased from 41 (38-45) to 31 (28-33) kg/m² (P = .01) with absolute percent reduction of 24% after BS. Five out of seven patients with diabetes (71%) stopped taking insulin medication (P = .03). All patients with hypertension decreased their medications to a single drug (P = 0.03). Five patients (63%) underwent RT after 25 (5-45) months. All were discharged with functioning grafts with median serum creatinine of 81 (60-90) mmol/L and estimated glomerular filtration rate (eGFR) of 79 (61-91) mL/min/1.73m². One patient (20%) was reoperated for wound infection. After follow-up of 31 (8-62) months, all patients have a functioning graft. No statistically significant differences were identified between both groups in regard to post-operative complications and graft function at discharge and at the last follow-up (P > .05).

Conclusions: BS is safe and effective in pre-transplant patients with obesity and associated with comparable RT outcomes to those without a history of BS.