Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN; Von Liebig Transplant Center, Mayo Clinic, Rochester, MN.
Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN.
Mayo Clin Proc. 2024 May;99(5):705-715. doi: 10.1016/j.mayocp.2024.01.017.
To describe the outcomes of kidney transplant (KT) candidates with obesity undergoing sleeve gastrectomy (SG) to meet the criteria for KT.
Retrospective analysis was conducted of electronic medical records of KT candidates with obesity (body mass index >35 kg/m) who underwent SG in our institution. Weight loss, adverse health events, and the listing and transplant rates were abstracted and compared with the nonsurgical cohort.
The SG was performed in 54 patients; 50 patients did not have surgery. Baseline demographic characteristics were comparable at the time of evaluation. Mean body mass index ± SD of the SG group was 41.7±3.6 kg/m at baseline (vs 41.5±4.3 kg/m for nonsurgical controls); at 2 and 12 months after SG, it was 36.4±4.1 kg/m and 32.6±4.0 kg/m (P<.01 for both). In the median follow-up time of 15.5 months (interquartile range, 6.4 to 23.9 months), SG was followed by active listing (37/54 people), and 20 of 54 received KT during a median follow-up time of 20.9 months (interquartile range, 14.7 to 28.3 months) after SG. In contrast, 14 of 50 patients in the nonsurgical cohort were listed, and 5 received a KT (P<.01). Three patients (5.6%) experienced surgical complications. There was no difference in overall hospitalization rates and adverse health outcomes, but the SG cohort experienced a higher risk of clinically significant functional decline.
In KT candidates with obesity, SG appears to be effective, with 37% of patients undergoing KT during the next 18 months (P<.01). Further research is needed to confirm and to improve the safety and efficacy of SG for patients with obesity seeking a KT.
描述接受袖状胃切除术（SG）以符合肾移植（KT）标准的肥胖 KT 候选者的结局。
对我院接受 SG 的肥胖（体重指数＞35kg/m）KT 候选者的电子病历进行回顾性分析。摘要并比较了减重、不良健康事件、列入名单和移植率，并与非手术组进行比较。
54 例患者接受了 SG，50 例患者未接受手术。评估时，SG 组的基线人口统计学特征相似。SG 组的基线平均体重指数±标准差为 41.7±3.6kg/m（非手术对照组为 41.5±4.3kg/m）；SG 后 2 个月和 12 个月时，分别为 36.4±4.1kg/m 和 32.6±4.0kg/m（均 P＜0.01）。在 15.5 个月的中位随访时间（四分位间距，6.4 至 23.9 个月）中，SG 后有 37/54 人积极列入名单，54 人中有 20 人在 SG 后中位随访时间 20.9 个月（四分位间距，14.7 至 28.3 个月）接受 KT。相比之下，非手术组 14 例患者列入名单，5 例患者接受 KT（P＜0.01）。3 例患者（5.6%）发生手术并发症。总体住院率和不良健康结局无差异，但 SG 组发生严重功能下降的风险较高。
在肥胖的 KT 候选者中，SG 似乎有效，在接下来的 18 个月内有 37%的患者接受 KT（P＜0.01）。需要进一步研究以确认和提高肥胖患者接受 KT 时 SG 的安全性和有效性。
