Gazzetta P G, Bissolati M, Saibene A, Ghidini C G A, Guarneri G, Giannone F, Adamenko O, Secchi A, Rosati R, Socci C
Metabolic, Bariatric and Transplant Surgery Unit, San Raffaele Hospital, Milan, Italy.
Internal and Endocrine Medicine Unit, San Raffaele Hospital, Milan, Italy.
Transplant Proc. 2017 May;49(4):646-649. doi: 10.1016/j.transproceed.2017.02.032.
During the last century, obesity has become a global epidemic. The effect of obesity on renal transplantation may occur in perioperative complications and impairment of organ function. Obese patients have metabolic derangements that can be exacerbated after transplantation and obesity directly impacts most transplantation outcomes. These recipients are more likely to develop adverse graft events, such as delayed graft function and early graft loss. Furthermore, obesity is synergic to some immunosuppressive agents in triggering diabetes and hypertension. As behavioral weight loss programs show disappointing results in these patients, bariatric surgery has been considered as a means to achieve rapid and long-term weight loss. Up-to-date literature shows laparoscopic bariatric surgery is feasible and safe in transplantation candidates and increases the rate of transplantation eligibility in obese patients with end-stage organ disease. There is no evidence that restrictive procedures modify the absorption of immunosuppressive medications. From 2013 to 2016 we performed six bariatric procedures (sleeve gastrectomy) on obese patients with renal transplantation; mean preoperative body mass index (BMI) was 39.8 kg/m. No postoperative complication was observed and no change in the immunosuppressive medications regimen was needed. Mean observed estimated weight loss was 27.6%, 44.1%, 74.2%, and 75.9% at 1, 3, 6, and 12 months follow-up, respectively. Our recommendation is to consider patients with BMI >30 kg/m as temporarily ineligible for transplantation and as candidates to bariatric surgery if BMI >35 kg/m. We consider laparoscopic sleeve gastrectomy as a feasible, first-choice procedure in this specific population.
在上个世纪，肥胖已成为一种全球流行病。肥胖对肾移植的影响可能发生在围手术期并发症和器官功能损害方面。肥胖患者存在代谢紊乱，移植后可能会加剧，而且肥胖直接影响大多数移植结果。这些受者更有可能发生不良的移植事件，如移植功能延迟和早期移植失败。此外，肥胖与某些免疫抑制剂协同作用会引发糖尿病和高血压。由于行为减肥计划在这些患者中效果不佳，减重手术已被视为实现快速和长期减重的一种手段。最新文献表明，腹腔镜减重手术对于移植候选人是可行且安全的，并且提高了终末期器官疾病肥胖患者的移植资格率。没有证据表明限制性手术会改变免疫抑制药物的吸收。2013年至2016年，我们对肥胖肾移植患者进行了6例减重手术（袖状胃切除术）；术前平均体重指数（BMI）为39.8kg/m²。未观察到术后并发症，也无需改变免疫抑制药物治疗方案。在1、3、6和12个月的随访中，观察到的平均估计体重减轻分别为27.6%、44.1%、74.2%和75.9%。我们的建议是，将BMI>30kg/m²的患者视为暂时不适合移植，如果BMI>35kg/m²则作为减重手术的候选人。我们认为腹腔镜袖状胃切除术是这一特定人群可行的首选手术。
