Matar Abraham J, Wright Matthew, Megaly Michael, Dryden Michael, Ramanathan Karthik, Humphreville Vanessa, Mathews David V, Sarumi Heidi, Kopacz Kristi, Leslie Daniel, Ikramuddin Sayeed, Finger Erik B, Kandaswamy Raja
Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
Surg Obes Relat Dis. 2025 Apr;21(4):489-496. doi: 10.1016/j.soard.2024.11.001. Epub 2024 Dec 2.
The clinical impact of bariatric surgery (BS) prior to pancreas transplantation (PTx) is unclear.
University of Minnesota Hospital, Minneapolis, MN.
This was a single center retrospective case-controlled study of all patients January 1, 1998 and May 1, 2024 with a history of BS prior to PTx. Patients were matched (1:3) with control patients by recipient age, body mass index (BMI) at PTx, type of transplant, primary versus retransplant, and year of PTx.
Among 1542 transplants, 17 patients had a history of BS prior to PTx, with an overall incidence of 1.1%. Eleven patients underwent roux-en-y gastric bypass, 5 underwent sleeve gastrectomy (SG), and one underwent vertical-banded gastroplasty. Eleven underwent simultaneous pancreas kidney transplant, 5 underwent pancreas transplant alone, and one underwent pancreas after kidney transplant. The median time (interquartile range [IQR]) between BS and PTx was 2.9 yrs (4.6) and ranged from .7 to 20.6 yrs. Compared to the non-BS group, patients in the BS group had similar rates of graft thrombosis (5.9% versus 3.9%, P = .76) and rejection (29.4% versus 29.4%, P > .99). Length of stay following PTx (P = .22), number of 30-day readmissions (P = .24), and number of 1-year readmissions (P = .70) were not different between the two groups. Median death-censored graft survival (9.4 yrs versus median not reached, P = .23) and patient survival (9.4 yrs versus median not reached, P = .18) were similar between the BS and non-BS groups. Finally, six patients underwent BS with the specific intention of reaching the acceptable BMI threshold for PTx. Median BMI was reduced from 37.4 prior to BS to 26.4 at time of PTx. Median time from BS to PTx was 2.4 yrs. At 4 yr follow-up, graft and patient survival was 100%.
This represents the largest series of patients with BS prior to PTx. Perioperative complications are not increased in patients undergoing PTx with a history of prior BS and long-term outcomes are equivalent. Patients with a prohibitive BMI for PTx eligibility should be considered for BS without concern for detrimental effect on post-transplant outcomes.
胰腺移植（PTx）前进行减重手术（BS）的临床影响尚不清楚。
明尼苏达大学医院，明尼阿波利斯，明尼苏达州。
这是一项单中心回顾性病例对照研究，研究对象为1998年1月1日至2024年5月1日期间所有在PTx前有BS病史的患者。根据受者年龄、PTx时的体重指数（BMI）、移植类型、初次移植与再次移植以及PTx年份，将患者与对照患者进行匹配（1:3）。
在1542例移植手术中，17例患者在PTx前有BS病史，总体发生率为1.1%。11例患者接受了胃旁路手术，5例接受了袖状胃切除术（SG），1例接受了垂直束带胃成形术。11例接受了同期胰肾联合移植，5例接受了单纯胰腺移植，1例接受了肾移植后胰腺移植。BS与PTx之间的中位时间（四分位间距[IQR]）为2.9年（4.6年），范围为0.7至20.6年。与非BS组相比，BS组患者的移植物血栓形成率（5.9%对3.9%，P = 0.76）和排斥反应率（29.4%对29.4%，P > 0.99）相似。两组之间PTx后的住院时间（P = 0.22）、30天再入院次数（P = 0.24）和1年再入院次数（P = 0.70）没有差异。BS组和非BS组的中位死亡 censored移植物存活率（9.4年对未达到中位值，P = 0.23）和患者存活率（9.4年对未达到中位值，P = 0.18）相似。最后，6例患者进行BS的特定目的是达到PTx可接受的BMI阈值。BMI中位数从BS前的37.4降至PTx时的26.4。从BS到PTx的中位时间为2.4年。在4年随访时，移植物和患者存活率为100%。
这是PTx前有BS病史的患者中规模最大的系列研究。有BS病史的患者在接受PTx时围手术期并发症没有增加，长期结果相当。对于因BMI过高而不符合PTx条件的患者，应考虑进行BS，而不必担心对移植后结果有不利影响。
