Department of Surgery, Center for Bariatric Surgery, McGill University, Montreal General Hospital, 1650 Cedar Avenue, Room: E16-165A, H3G 1A4, Montreal, QC, Canada.
Multi-organ Transplant Program, Department of Surgery, McGill University, Montreal, QC, Canada.
Surg Endosc. 2020 Jun;34(6):2657-2664. doi: 10.1007/s00464-019-07042-z. Epub 2019 Jul 31.
Obese individuals suffering from advanced chronic kidney disease (CKD) may be precluded from accessing kidney transplantation. Bariatric surgery is an effective treatment for obesity and related conditions but its use in those with severe CKD remains limited due to morbidity concerns. We aimed to evaluate the safety and efficacy of sleeve gastrectomy (SG) in patients with severe CKD as a bridging strategy towards kidney transplant candidacy.
This is a single-center retrospective study of a prospectively collected database of obese patients referred by the multi-organ transplant team for surgical weight loss, who underwent SG during 2013-2018. The primary outcome was 90-day major morbidity. Secondary outcomes included weight loss, and successful kidney transplantation. Descriptive statistics are expressed as count (percent) or median (interquartile range).
32 patients met inclusion criteria. 18 (56%) were male with a median age and BMI of 51 (11) years and 42.3 (5.2) kg/m, respectively. 29 (91%) patients were on dialysis for a median duration of 28 months before SG. Diabetes, hypertension, and dyslipidemia were present in 15 (47%), 25 (78%), and 21 (66%) patients, respectively. At 90 days after SG, there were no leaks, reoperations, or mortality. The median length of stay was 2 (1.3) days. At 1 year, change in BMI and percent excess weight loss (EWL) were -9.8 (3.7) kg/m and 56% (27), respectively. In the year after SG, 20 (63%) patients were listed for transplant. 14 (44%) underwent successful kidney transplantation. One patient died while waiting for transplant. At time of transplant, median change in BMI and EWL were -9.0 (5.5) kg/m and 59% (30), respectively. After transplant, no patient required dialysis at a median follow-up of 17 (32) months.
SG is safe and effective for weight loss and bridging to candidacy for kidney transplantation in patients with severe CKD. The acceptable safety and efficiency of SG in this high-risk population makes it an optimal choice as a bridging procedure.
患有晚期慢性肾脏病（CKD）的肥胖个体可能无法接受肾移植。减重手术是治疗肥胖症和相关疾病的有效方法，但由于担心发病率，其在严重 CKD 患者中的应用仍然有限。我们旨在评估胃袖状切除术（SG）作为桥接策略在严重 CKD 患者中获得肾移植候选资格的安全性和有效性。
这是一项对多器官移植团队转诊的肥胖患者进行前瞻性收集数据库的单中心回顾性研究，这些患者在 2013 年至 2018 年期间接受了 SG。主要结果是 90 天主要发病率。次要结果包括体重减轻和成功的肾移植。描述性统计数据表示为计数（百分比）或中位数（四分位距）。
32 名患者符合纳入标准。18 名（56%）为男性，中位年龄和 BMI 分别为 51（11）岁和 42.3（5.2）kg/m。29 名（91%）患者在 SG 前接受透析中位时间为 28 个月。15 名（47%）、25 名（78%）和 21 名（66%）患者分别患有糖尿病、高血压和血脂异常。SG 后 90 天无漏诊、再手术或死亡。中位住院时间为 2（1.3）天。1 年后，BMI 和超重减轻百分比（EWL）的变化分别为-9.8（3.7）kg/m 和 56%（27）。SG 后 1 年内，20 名（63%）患者接受了移植。14 名（44%）成功接受了肾移植。1 名患者在等待移植时死亡。在移植时，BMI 和 EWL 的中位数变化分别为-9.0（5.5）kg/m 和 59%（30）。在移植后，中位随访 17（32）个月时，无患者需要透析。
SG 是安全有效的，可用于严重 CKD 患者的减肥和桥接肾移植候选资格。SG 在这一高危人群中的可接受安全性和效率使其成为桥接手术的理想选择。
