Di Napoli Marissa, Rouhi Armaun D, Dumon Kristoffel R, Castle Rose, Williams Noel N, Baimas-George Maria, Kennealey Peter T, Nydam Trevor L, Choudhury Rashikh A
Division of Transplantation, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Surg Obes Relat Dis. 2025 Aug;21(8):921-928. doi: 10.1016/j.soard.2025.04.001. Epub 2025 Apr 12.
Obesity can be a barrier to accessing kidney transplantation as there is significant variability in body mass index (BMI) criteria among transplant centers. Effective weight loss strategies are crucial for improving access to kidney transplantation in the end-stage renal disease (ESRD) population with obesity.
To estimate access to kidney transplantation following diet and exercise, sleeve gastrectomy (SG), and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in this population.
University hospital, United States.
A decision-analytic Markov state transition model was created to simulate the outcomes of ESRD patients with obesity who were ineligible for kidney transplantation unless they achieved a BMI <35 kg/m. Base case patients were defined as a 45-year-old patient with a preintervention BMI of 45 kg/m. Model inputs were obtained from literature review.
SG resulted in 14% of patients receiving kidney transplantation at 10 years, compared to 2.5% of patients in the GLP-1 RA group, and <1% of patients with diet and exercise. Upon sensitivity analysis, SG demonstrated a survival advantage over both diet and exercise and GLP-1 RAs above a BMI of 34.4 kg/m and 37.5 kg/m, respectively, assuming 100% compliance with diet and exercise or medication.
SG improves access to kidney transplantation compared to diet and exercise and GLP-1 RAs. As new obesity medications continue to be developed and increase in popularity, the risks and benefits of these therapies should be compared to currently available weight loss therapies in an effort to optimize obesity management in this population.
肥胖可能成为肾移植的障碍，因为各移植中心的体重指数（BMI）标准存在显著差异。有效的减肥策略对于改善肥胖的终末期肾病（ESRD）患者获得肾移植的机会至关重要。
评估该人群通过饮食和运动、袖状胃切除术（SG）以及胰高血糖素样肽-1受体激动剂（GLP-1 RAs）后获得肾移植的机会。
美国大学医院。
建立了一个决策分析马尔可夫状态转移模型，以模拟肥胖的ESRD患者的结局，这些患者除非BMI<35 kg/m²，否则无资格接受肾移植。基础病例患者定义为一名45岁、干预前BMI为45 kg/m²的患者。模型输入数据来自文献综述。
10年后，SG组有14%的患者接受了肾移植，而GLP-1 RA组为2.5%，饮食和运动组<1%。敏感性分析显示，假设饮食和运动或药物治疗的依从性为100%，在BMI分别高于34.4 kg/m²和37.5 kg/m²时，SG在生存方面优于饮食和运动组以及GLP-1 RA组。
与饮食和运动以及GLP-1 RA相比，SG改善了肾移植的可及性。随着新的肥胖药物不断研发并日益普及，应将这些疗法的风险和益处与现有的减肥疗法进行比较，以优化该人群的肥胖管理。
