Teamwork Enables Transplant for Those With Obesity, ESRD

TOPLINE:

A collaborative program between bariatric and transplant teams can enable patients with morbid obesity and end-stage renal disease (ESRD) to become eligible for a kidney transplant, a single-center study showed. 

METHODOLOGY:

• A cohort of 183 patients (mean age, 42.9 years; 66.7% women) was referred for metabolic bariatric surgery (MBS) due to obesity, which impeded their eligibility for kidney transplantation.
• After dropouts for various reasons (insurance, medical issues, not completing the workup, etc.), 36 patients underwent bariatric surgery: 20 had Roux-en-Y Gastric Bypass (RYGB), and 16 had sleeve gastrectomy (SG).
• In the RYGB group, 12 patients identified as Black individuals and eight as White individuals; in the SG group, 14 identified as Black individuals and two as White individuals.
• Among referrals, 10 patients underwent transplant and 15 were waitlisted at the time of the study. 

TAKEAWAY: 

• The mean starting body mass index for all referrals was 46.4 kg/m² and was 33.9 kg/m² at the time of transplant (27% reduction).
• The average number of hypertension medications decreased from two before surgery to one post surgery.
• A1C levels improved from a preoperative average of 6.2 to a postoperative level of 5.2.
• All transplants are currently functioning, with a median creatinine of 1.5 mg/dL and a median glomerular filtration rate of 46.

IN PRACTICE:

“[A] collaborative effort with an MBS and transplant team offers a pathway for morbidly obese ESRD candidates who would otherwise be denied a transplant… A combined program helps alleviate disparities in healthcare and transplant access, especially for [African Americans] and communities with socioeconomic barriers, who are more affected with obesity disease,” the authors wrote.

SOURCE: 

Led by Shauna Levy, MD, of the Division of Bariatric and Minimally Invasive Surgery, Tulane University, New Orleans, led the study, which was published online in the Journal of the American College of Surgeons.

LIMITATIONS:

The study had a high dropout rate of patients unwilling or unable to undergo surgery and having various postoperative complications, including hypotension as well as the need to change dialysis modality for peritoneal dialysis to hemodialysis due to catheter issues.

DISCLOSURES:

The study did not receive any specific funding. The authors reported no disclosures relevant to this work.