Bariatric Surgery to Improve Candidacy for Kidney Transplantation: A Systematic Review and Meta-Analysis
1University of Alabama at Birmingham, Birmingham, AL, 2University of Southern California, Los Angeles, CA
Meeting: 2020 American Transplant Congress
Abstract number: C-039
Keywords: Kidney transplantation, Meta-analysis, Obesity, Waiting lists
Session Information
Date: Saturday, May 30, 2020
Session Name: Poster Session C: Kidney: Cardiovascular and Metabolic Complications
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
Location: Virtual
*Purpose: There is a growing epidemic of obesity in patients with end stage kidney disease in need of kidney transplant, paralleling the general population. Most transplant centers have BMI cutoffs of 35-40 kg/m2 to be listed, but medical weight loss may not be feasible in many potential transplant candidates (KTc). In these patients, bariatric surgery may be an effective means to increase transplant candidacy.
*Methods: 790 manuscripts were identified through a PubMed search for any bariatric surgery and solid-organ transplant. 173 full texts were reviewed, and 18 were included in this study. Included studies used bariatric surgery as a means for weight loss in obese patients with the goal of waitlisting. Reasons for exclusion included: bariatric surgery not performed, article written in non-English language, editorials/reviews, and decision modeling analyses.
*Results: 285 patients underwent bariatric surgery to improve candidacy for transplant. 231 patients had end-stage renal disease, and 45 had chronic kidney disease . Sleeve gastrectomy was performed in 196 (68.8%) patients, being the most common procedure, followed by Roux-en-Y gastric bypass (78; 27.3%). Diabetes was the most common reported cause of kidney disease (59/126; 46.8%).The mean age was 49.7 (SD 7.4) years, and BMI decreased from 43.9 (SD 5.3) at the time of bariatric surgery to 33.7 (SD 5.4) at a mean follow up of 32.9 (SD 21.4) months. Of 285 patients, 143 (50%) achieved listing, and 83 (29%) ultimately were transplanted at an average of 19.9 (SD 14.3) months after bariatric surgery. There were 24 complications in the first 30 days after bariatric surgery. According to the Clavien-Dindo classification system, there were 10 class I, 3 class II, 3 class IIIa, 4 class IIIb, 3 class IVa, and 1 class V complications.
*Conclusions: Bariatric surgery may be a promising option for select obese KTc. These findings likely represent the best expected outcomes due to inherent publication and candidate selection bias. While encouraging, large systematic studies are needed to better define the role of bariatric surgery in obese KTc.
To cite this abstract in AMA style:
Purvis J, Mehta S, Stahl R, Grams J, Hanaway M, Anderson D, Young C, Cannon R, Lewis C, Terrault N, Locke J, Orandi B. Bariatric Surgery to Improve Candidacy for Kidney Transplantation: A Systematic Review and Meta-Analysis [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/bariatric-surgery-to-improve-candidacy-for-kidney-transplantation-a-systematic-review-and-meta-analysis/. Accessed October 21, 2020.« Back to 2020 American Transplant Congress