IS BARIATRIC SURGERY THE ANSWER FOR OBESE TRANSPLANT CANDIDATES

It is estimated that a third of the US adult population is obese, defined as a BMI above 30 kg/m2. Approximately 35 to 40 percent of renal failure patients are obese as well, a condition that makes it hard for them to receive a timely kidney transplant. Studies show that for dialysis dependent patients with a BMI more than 40 kg/m2, it is 44 percent less likely that they are offered a new lease of life in the form of a kidney transplant. Transplant centers all across the nation have strict inclusion criteria and most of them will not put someone with a BMI more than 40 kg/m2 on the waiting list. This condition has been put in place because research shows a higher complication rate and shorter survival time for obese transplant recipients.

Bariatric surgery has been suggested as an option for patients on the waiting list and for recipients of a kidney transplant. Most bariatric procedures are fall under the following three procedures:

a) Laparoscopic adjustable gastric banding (LAGB) which is the least invasive option and involves placing a silicone band around the stomach to decrease its size. Another advantage is that it does not alter the anatomy of the stomach and therefore does not cause any malabsorption, which may affect the patient’s ability to absorb the medications required to prevent rejection of the transplant. Disadvantages include the presence of a foreign body which could cause stomach erosion and infection as well as a slower rate of weight loss compared with other procedures.
b) Laparoscopic Roux-en-Y gastric bypass (RYGB) has been shown to have the most weight loss but does cause malabsorption. Multiple studies have shown the safety and effectiveness of this surgery to induce weight loss while on the waiting list.
c) Laparoscopic sleeve gastrectomy (SG) is a relatively newer option and involves stapling of a part of the stomach to decrease its size. No malabsorption is encountered but long term data is currently lacking.

Factors to consider when choosing the best option include:

a) Which organ is being transplanted
b) Amount of weight loss necessary to get on the list
c) How urgent is the transplant
d) Any past surgeries that could make it a challenge to do the procedure
e) Co-morbidities

Bariatric surgery has been shown in many but small studies that it has immense benefits to induce a dramatic and rapid weight loss in both the pre- and post-transplant setting. Secondary benefits to weight loss include decrease in hypertension, decreased need for medications to treat diabetes, improved cardiovascular health and an improvement in kidney function.