Kienzl-Wagner Katrin, Weissenbacher Annemarie, Gehwolf Philipp, Wykypiel Heinz, Öfner Dietmar, Schneeberger Stefan
Department of Visceral, Transplant, and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria.
Department of Visceral, Transplant, and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria.
Surg Obes Relat Dis. 2017 Jun;13(6):909-915. doi: 10.1016/j.soard.2017.01.005. Epub 2017 Jan 6.
The prevalence of obesity and obesity-related morbidity in end-stage renal disease patients is rising. Although it is established that obesity does not abrogate the transplant benefit with respect to lower long-term mortality and cardiovascular risk, it is associated with increased graft failure, delayed graft function, surgical complications, prolonged hospital stay, and costs.
To examine the safety and efficacy of LSG (laparoscopic sleeve gastrectomy) in renal transplant candidates and evaluate transplant outcomes.
Single-center prospective nonrandomized trial METHODS: We here report on a prospective single-center trial establishing a 2-step approach for obese renal transplant candidates. Patients with end-stage renal disease and a BMI (body mass index) of 35 kg/m or higher underwent laparoscopic sleeve gastrectomy. After reaching a BMI of<35 kg/m, patients were waitlisted for kidney transplantation. Age, gender, body mass index (BMI), associated co-morbidities, cause of end-stage renal disease, surgical complications, and outcome after kidney transplantation (graft survival, incidence of delayed graft function, incidence of rejection, serum creatinine) were collected.
LSG was performed in 8 renal transplant candidates with a mean BMI of 38.8 kg/m each. BMI dropped to below 35 kg/m within a median of 3 months. Percent excess body mass index loss (%EBMIL) was 62.7% at 1 year after LSG. Within 17 months (mean) after metabolic surgery, 7 patients underwent kidney transplantation. All transplants were successful with a serum creatinine of 1.9±.8 mg/dL at discharge and stable allograft function thereafter. Mean follow-up was 3.2±1.4 years; no patient was lost to follow-up.
LSG is safe and efficacious for treatment of obesity in renal transplant candidates. Rapid and sustained weight loss and subsequent waitlisting for kidney transplantation may reduce overall and in particular posttransplant patient morbidity.
终末期肾病患者中肥胖及肥胖相关发病率呈上升趋势。虽然已确定肥胖在降低长期死亡率和心血管风险方面并不消除移植获益，但它与移植失败增加、移植肾功能延迟、手术并发症、住院时间延长及费用增加相关。
研究腹腔镜袖状胃切除术（LSG）在肾移植候选者中的安全性和有效性，并评估移植结局。
单中心前瞻性非随机试验
我们在此报告一项前瞻性单中心试验，该试验为肥胖肾移植候选者建立了一种两步法。终末期肾病且体重指数（BMI）为35kg/m或更高的患者接受了腹腔镜袖状胃切除术。在BMI降至<35kg/m后，患者被列入肾脏移植等待名单。收集了年龄、性别、体重指数（BMI）、相关合并症、终末期肾病病因、手术并发症及肾移植后的结局（移植物存活、移植肾功能延迟发生率、排斥反应发生率、血清肌酐）。
8例肾移植候选者接受了LSG，平均BMI为38.8kg/m。BMI在中位3个月内降至35kg/m以下。LSG后1年时，超重体重指数丢失百分比（%EBMIL）为62.7%。在代谢手术后17个月（平均）内，7例患者接受了肾脏移植。所有移植均成功，出院时血清肌酐为1.9±0.8mg/dL，此后移植物功能稳定。平均随访3.2±1.4年；无患者失访。
LSG治疗肾移植候选者的肥胖是安全有效的。快速且持续的体重减轻以及随后列入肾脏移植等待名单可能会降低总体尤其是移植后患者的发病率。
