Kidney transplantation is the treatment of choice for patients with end stage renal disease (ESRD). However, transplant centers often have body mass index (BMI) requirements that restrict ESRD patients with obesity from being waitlisted for a kidney. The most recent reported prevalence of obesity (BMI ≥ 30 kg/m2) among patients with end stage renal disease (ESRD) is 44.1%. This study aimed to determine whether bariatric surgery is a safe and effective weight reduction option for patients with a BMI ≥ 40 kg/m2 seeking access to the transplant waitlist.
A retrospective review of our internal database was conducted for ESRD patients on dialysis who underwent bariatric surgery from January 2012 to February 2017. Patient demographics, comorbidities, BMI, type of surgery, length of stay, complications, mortality and excess weight loss were collected. Data was managed using Microsoft Office Excel 2011.
A total of 1839 patients underwent bariatric surgery from January 2012 to February 2017. Of these, twelve (0.65%) were ESRD patients on dialysis, with a mean follow-up period of 1.68 years post-surgery (range 0.3 – 4.8). There were 8 (66.7%) female patients and 4 (33.3%) male patients with a mean age of 44.4 ± 8.25, and a mean preoperative BMI of 44.8 ± 8.20. Patient characteristics are shown in Table 1. Eight patients underwent laparoscopic sleeve gastrectomy (66.7%), three underwent LRYGB (25%) and one underwent LGB (8.3%). Only one of the patients experienced a post-operative complication requiring readmission – namely colitis and an abdominal abscess, both of which required readmission. One patient died at 7 months after surgery from reasons unrelated to bariatric procedure. Five (41.7%) of the 12 dialysis patients became active on the transplant waitlist, and two patients went on to receive renal transplants at 28 and 24 months post-bariatric surgery, respectively. Both patients who received renal transplants had functioning allografts, and were off dialysis, with creatinine levels of 1.27 and 1.76 at 1-year post-transplant, respectively.
In our experience, bariatric surgery is a safe and effective weight loss procedure that allowed, dialysis-dependent ESRD patients with obesity to become active on the transplant waitlist, facilitating access to this life changing therapy.