Impact of panniculectomy on transplant candidacy of obese patients with chronic kidney disease declined for kidney transplantation because of a high-risk abdominal panniculus: A pilot study

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Abstract

Background: Obese patients can develop a large lower abdominal panniculus (worsened by significant weight loss). Patients with advanced chronic kidney disease (CKD) affected by this obesity-related sequela are not infrequently declined for kidney transplantation because of the high risk for serious wound-healing complications. We hypothesized that pretransplant panniculectomy in these patients would (1) render them transplant candidates, and (2) result in low posttransplant wound-complication rates. Methods: In a pilot study, adult patients with CKD who had a high-risk panniculus as the only absolute contraindication to kidney transplantation subsequently were referred to a plastic surgeon to undergo a panniculectomy in order to become transplant candidates. We analyzed the effect of panniculectomy on (1) transplant candidacy and (2) wait list and transplant outcomes (04/2008-06/2014). Results: Overall, 36 patients had panniculectomy (median prior weight loss, 38 kg); all were wait-listed with these outcomes: (1) 22 (62%) patients were transplanted; (2) 7 (19%) remain listed; and (3) 7 (19%) were removed from the wait list. Survival after panniculectomy was greater for those transplanted versus not transplanted (at 5 years, 95% vs 35%, respectively; P = .002). For the 22 kidney recipients, posttransplant wound-complication rate was 5% (1 minor subcutaneous hematoma). Conclusion: For obese CKD patients with a high-risk abdominal panniculus, panniculectomy was highly effective in obtaining access to the transplant wait list and successful kidney transplantation. This approach is particularly pertinent for CKD patients because they are disproportionally affected by the obesity epidemic and because obese CKD patients already face multiple other barriers to transplantation.

Original languageEnglish (US)
JournalSurgery (United States)
DOIs
StateAccepted/In press - 2015

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Abdominoplasty
Chronic Renal Insufficiency
Kidney Transplantation
Transplants
Weight Loss
Obesity
Wounds and Injuries
Hematoma
Wound Healing
Transplantation
Kidney

ASJC Scopus subject areas

  • Surgery

Cite this

@article{78ec9458bcf34c57b70e3ce2ddf0ce22,
title = "Impact of panniculectomy on transplant candidacy of obese patients with chronic kidney disease declined for kidney transplantation because of a high-risk abdominal panniculus: A pilot study",
abstract = "Background: Obese patients can develop a large lower abdominal panniculus (worsened by significant weight loss). Patients with advanced chronic kidney disease (CKD) affected by this obesity-related sequela are not infrequently declined for kidney transplantation because of the high risk for serious wound-healing complications. We hypothesized that pretransplant panniculectomy in these patients would (1) render them transplant candidates, and (2) result in low posttransplant wound-complication rates. Methods: In a pilot study, adult patients with CKD who had a high-risk panniculus as the only absolute contraindication to kidney transplantation subsequently were referred to a plastic surgeon to undergo a panniculectomy in order to become transplant candidates. We analyzed the effect of panniculectomy on (1) transplant candidacy and (2) wait list and transplant outcomes (04/2008-06/2014). Results: Overall, 36 patients had panniculectomy (median prior weight loss, 38 kg); all were wait-listed with these outcomes: (1) 22 (62{\%}) patients were transplanted; (2) 7 (19{\%}) remain listed; and (3) 7 (19{\%}) were removed from the wait list. Survival after panniculectomy was greater for those transplanted versus not transplanted (at 5 years, 95{\%} vs 35{\%}, respectively; P = .002). For the 22 kidney recipients, posttransplant wound-complication rate was 5{\%} (1 minor subcutaneous hematoma). Conclusion: For obese CKD patients with a high-risk abdominal panniculus, panniculectomy was highly effective in obtaining access to the transplant wait list and successful kidney transplantation. This approach is particularly pertinent for CKD patients because they are disproportionally affected by the obesity epidemic and because obese CKD patients already face multiple other barriers to transplantation.",
author = "Christoph Troppmann and Chandrase Santhanakrishnan and Kuo, {Jennifer H.} and Bailey, {Chad M.} and Perez, {Richard V} and Wong, {Michael S}",
year = "2015",
doi = "10.1016/j.surg.2015.12.001",
language = "English (US)",
journal = "Surgery (United States)",
issn = "0039-6060",
publisher = "Mosby Inc.",

}

TY - JOUR

T1 - Impact of panniculectomy on transplant candidacy of obese patients with chronic kidney disease declined for kidney transplantation because of a high-risk abdominal panniculus

T2 - A pilot study

AU - Troppmann, Christoph

AU - Santhanakrishnan, Chandrase

AU - Kuo, Jennifer H.

AU - Bailey, Chad M.

AU - Perez, Richard V

AU - Wong, Michael S

PY - 2015

Y1 - 2015

N2 - Background: Obese patients can develop a large lower abdominal panniculus (worsened by significant weight loss). Patients with advanced chronic kidney disease (CKD) affected by this obesity-related sequela are not infrequently declined for kidney transplantation because of the high risk for serious wound-healing complications. We hypothesized that pretransplant panniculectomy in these patients would (1) render them transplant candidates, and (2) result in low posttransplant wound-complication rates. Methods: In a pilot study, adult patients with CKD who had a high-risk panniculus as the only absolute contraindication to kidney transplantation subsequently were referred to a plastic surgeon to undergo a panniculectomy in order to become transplant candidates. We analyzed the effect of panniculectomy on (1) transplant candidacy and (2) wait list and transplant outcomes (04/2008-06/2014). Results: Overall, 36 patients had panniculectomy (median prior weight loss, 38 kg); all were wait-listed with these outcomes: (1) 22 (62%) patients were transplanted; (2) 7 (19%) remain listed; and (3) 7 (19%) were removed from the wait list. Survival after panniculectomy was greater for those transplanted versus not transplanted (at 5 years, 95% vs 35%, respectively; P = .002). For the 22 kidney recipients, posttransplant wound-complication rate was 5% (1 minor subcutaneous hematoma). Conclusion: For obese CKD patients with a high-risk abdominal panniculus, panniculectomy was highly effective in obtaining access to the transplant wait list and successful kidney transplantation. This approach is particularly pertinent for CKD patients because they are disproportionally affected by the obesity epidemic and because obese CKD patients already face multiple other barriers to transplantation.

AB - Background: Obese patients can develop a large lower abdominal panniculus (worsened by significant weight loss). Patients with advanced chronic kidney disease (CKD) affected by this obesity-related sequela are not infrequently declined for kidney transplantation because of the high risk for serious wound-healing complications. We hypothesized that pretransplant panniculectomy in these patients would (1) render them transplant candidates, and (2) result in low posttransplant wound-complication rates. Methods: In a pilot study, adult patients with CKD who had a high-risk panniculus as the only absolute contraindication to kidney transplantation subsequently were referred to a plastic surgeon to undergo a panniculectomy in order to become transplant candidates. We analyzed the effect of panniculectomy on (1) transplant candidacy and (2) wait list and transplant outcomes (04/2008-06/2014). Results: Overall, 36 patients had panniculectomy (median prior weight loss, 38 kg); all were wait-listed with these outcomes: (1) 22 (62%) patients were transplanted; (2) 7 (19%) remain listed; and (3) 7 (19%) were removed from the wait list. Survival after panniculectomy was greater for those transplanted versus not transplanted (at 5 years, 95% vs 35%, respectively; P = .002). For the 22 kidney recipients, posttransplant wound-complication rate was 5% (1 minor subcutaneous hematoma). Conclusion: For obese CKD patients with a high-risk abdominal panniculus, panniculectomy was highly effective in obtaining access to the transplant wait list and successful kidney transplantation. This approach is particularly pertinent for CKD patients because they are disproportionally affected by the obesity epidemic and because obese CKD patients already face multiple other barriers to transplantation.

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U2 - 10.1016/j.surg.2015.12.001

DO - 10.1016/j.surg.2015.12.001

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C2 - 26785910

AN - SCOPUS:84954348276

JO - Surgery (United States)

JF - Surgery (United States)

SN - 0039-6060

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