Adjustable Gastric Banding Compared to Diet and Exercise for Morbidly Obese Patients Awaiting Renal Transplant

Kenric Murayama, MD, Rashikh A Choudhury, BA, Kristoffel Dumon, MD, Noel Williams, MBBCh, Henry Glick, PhD, Peter Abt, MD, Ali Naji, MD, PhD

University of Pennsylvania

PURPOSE: Aggressive weight loss has been touted to improve renal transplant candidacy for morbidly obese patients. Our aim was to create a decision analytic model to estimate the impact of Lap-Band surgery on the survival of morbidly obese patients with end stage renal disease (ERSD) awaiting renal transplant. Two competing treatment strategies were analyzed: diet and exercise (DE) and Lap-Band surgery.

METHODS: A Markov state transition model was created to simulate the lives of morbidly obese patients with ESRD awaiting transplant using medical decision-making software ((DATA 3.5, Tree- Age Software, Inc, Williamstown, MA). Life expectancy following Lap-Band and one and two years of DE was estimated and compared within the framework of a clinical scenario where patients above a BMI of 35 kg/m2 were ineligible for transplantation, reflecting the BMI restrictions of many transplant centers. In addition to base case analysis (45 kg/m2 BMI pre-intervention), sensitivity analysis of initial BMI was completed. The Markov model parameters were extracted from the literature.

RESULTS: Lap-Band improved survival for patients compared to one year of DE. Lap-Band patients were transplanted sooner and in higher frequency compared to patients who underwent one year of DE. Using 35 kg/m2 as the upper limit for transplant eligibility, base case patients who underwent Lap-Band surgery gained 2.85 years of life while patients who underwent one and two years of DE gained 1.55 and 2.80 years of life respectively.

CONCLUSION: The decision whether or not to have Lap-Band surgery for a morbidly obese patient awaiting renal transplant is dependent on a constellation of factors which are specific to the individual patient. Our study demonstrates that Lap-Band improves survival in morbidly obese ESRD patients by improving access to transplant compared to one year of DE. When compared to two years of DE, survival is similar, but a minority of patients maintains the DE program for two years

Session: Poster Presentation

Program Number: P471

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