TY - JOUR
T1 - Roux-en-Y gastric bypass is an effective bridge to kidney transplantation
T2 - Results from a single center
AU - Thomas, Ian A.
AU - Gaynor, Jeffrey J.
AU - Joseph, Tameka
AU - De La Cruz-Munoz, Nestor
AU - Sageshima, Junichiro
AU - Kupin, Warren
AU - Chen, Linda J.
AU - Ciancio, Gaetano
AU - Burke, George W.
AU - Mattiazzi, Adela D.
AU - Roth, David
AU - Guerra, Giselle
PY - 2018/5/1
Y1 - 2018/5/1
N2 - Body mass index (BMI) > 35-40 kg/m2 is often a contraindication, while Roux-en-Y gastric bypass (RYGB) is performed to enable kidney transplantation. This single-center retrospective study evaluated pre- and post-transplant outcomes of 31 morbidly obese patients with end-stage renal disease having RYGB before kidney transplantation between July 2009 and June 2014. Fourteen RYGB patients were subsequently transplanted. Nineteen recipients not having GB with a BMI ≥ 36 kg/m2 at transplantation were used as historical controls. Mean BMI (±SE) before RYGB was 43.5 ± 0.7 kg/m2 (range: 35.4-50.5 kg/m2); 87.1% (27/31) achieved a BMI < 35 kg/m2. The percentage having improved diabetes/hypertension control was 29.0% (9/31); 25.8% (8/31) had complications (mostly minor) after RYGB. Among transplanted patients, blacks/Hispanics comprised 78.6% (11/14) and 84.2% (16/19) of RYGB and controls; 57.1% (8/14) and 63.2% (12/19) had a (mostly long-standing) pretransplant history of diabetes. While biopsy-proven acute rejection (BPAR) occurred significantly higher among RYGB vs control patients (6/14 vs 3/19, P =.03), patients developing T-cell BPAR were also significantly more likely to have a tacrolimus (TAC) trough level < 4.0 ng/mL within 3 weeks of T-cell BPAR (P =.0007). In Cox's model, the impact of having a TAC level < 4.0 ng/mg remained significant (P =.007) while the effect of RYGB was no longer significant (P =.13). Infections, graft, and patient survival were not significantly different. Despite obvious effectiveness in achieving weight loss, RYGB will need more careful post-transplant monitoring given the observed higher BPAR rate.
AB - Body mass index (BMI) > 35-40 kg/m2 is often a contraindication, while Roux-en-Y gastric bypass (RYGB) is performed to enable kidney transplantation. This single-center retrospective study evaluated pre- and post-transplant outcomes of 31 morbidly obese patients with end-stage renal disease having RYGB before kidney transplantation between July 2009 and June 2014. Fourteen RYGB patients were subsequently transplanted. Nineteen recipients not having GB with a BMI ≥ 36 kg/m2 at transplantation were used as historical controls. Mean BMI (±SE) before RYGB was 43.5 ± 0.7 kg/m2 (range: 35.4-50.5 kg/m2); 87.1% (27/31) achieved a BMI < 35 kg/m2. The percentage having improved diabetes/hypertension control was 29.0% (9/31); 25.8% (8/31) had complications (mostly minor) after RYGB. Among transplanted patients, blacks/Hispanics comprised 78.6% (11/14) and 84.2% (16/19) of RYGB and controls; 57.1% (8/14) and 63.2% (12/19) had a (mostly long-standing) pretransplant history of diabetes. While biopsy-proven acute rejection (BPAR) occurred significantly higher among RYGB vs control patients (6/14 vs 3/19, P =.03), patients developing T-cell BPAR were also significantly more likely to have a tacrolimus (TAC) trough level < 4.0 ng/mL within 3 weeks of T-cell BPAR (P =.0007). In Cox's model, the impact of having a TAC level < 4.0 ng/mg remained significant (P =.007) while the effect of RYGB was no longer significant (P =.13). Infections, graft, and patient survival were not significantly different. Despite obvious effectiveness in achieving weight loss, RYGB will need more careful post-transplant monitoring given the observed higher BPAR rate.
KW - kidney transplantation
KW - morbid obesity
KW - Roux-en-Y gastric bypass
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U2 - 10.1111/ctr.13232
DO - 10.1111/ctr.13232
M3 - Article
C2 - 29488657
AN - SCOPUS:85044945464
VL - 32
JO - Clinical Transplantation
JF - Clinical Transplantation
SN - 0902-0063
IS - 5
M1 - e13232
ER -