Philippe Bouchard, MD1, Jean Tchervenkov, MD1, Sebastian Demyttenaere, MD, MSc2, Olivier Court, MD2, Amin Andalib, MD, MSc2. 1McGill University, 2Center for Bariatric Surgery, Division of General Surgery, Department of Surgery, McGill University
Background: The prevalence of obesity and the associated metabolic syndrome are at an all time high. Some of these individuals will develop chronic kidney disease (CKD) and obesity can preclude them from accessing kidney transplantation. A powerful tool in managing obesity is bariatric surgery. We therefore aim to evaluate the efficacy and safety of Sleeve Gastrectomy (SG) in patients with severe CKD as a strategy towards kidney transplantation.
Methods: This is a retrospective cohort study of patients with elevated BMI evaluated by the multi-organ transplant program who underwent a sleeve gastrectomy between 2013 and 2018. Data was compiled from the prospective transplant program database, bariatric surgery database and chart reviews. The primary outcome was 90 days mortality and complications. Secondary outcomes included weight loss and transplantation. Descriptive statistics are expressed as count (percent) medians and (interquartile range).
Results: 32 patients met inclusion criteria. 18 (56%) were male. The median age was 51 and the median BMI 42.3 (5.9) kg/m2. 28 (88%) patients were on dialysis with a median time prior to SG of 28 months. Close to half, 15 (47%), were diabetic and 25 (78%) had hypertension. Obstructive sleep apnea was present in 16 (50%) patients.
At 90 days, there were no ICU admission, surgical leaks, reoperation or early mortality. The median length of stay was 2 (1.5) days. At 1 year, change in BMI and percent excess weight loss (%EWL) were 9.7 (2.2)kg/m2 and 55% (17%). At 2 years, the weight loss was maintained with BMI change of 9.4 (3.5)kg/m2 and %EWL of 54% (30%). The median cohort follow up time was 14 months and data was available at one and two year for 20 and 11 patients respectively.
During the study period, 1 patient died while waiting for transplantation. 14 (44%) patients in the cohort underwent successful cadaveric kidney transplantation. At time of transplant, the median %EWL and change in BMI were 59% (30%) and 9 (5.5)kg/m2. There were 2 acute rejections treated with pulse steroids and no return to dialysis at a median post-transplant follow-up of 17 (32) months.
Conclusion: In this cohort, the use of sleeve gastrectomy was safe and effective at inducing weight loss and allowed a high percentage of patient to undergo a kidney transplantation. Further research is needed to evaluate the benefits of pre-transplantation bariatric surgery on survival and graft outcomes following kidney transplant.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95067
Program Number: S121
Presentation Session: Bariatric IV – Quality and Outcomes
Presentation Type: Podium
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