Di Napoli Marissa, Rouhi Armaun D, Baimas-George Maria, Dumon Kristoffel, Castle Rose, Kennealey Peter, Nydam Trevor, Choudhury Rashikh
University of Colorado, Division of Transplantation, Department of Surgery, 1635 Aurora Court, C318, Aurora, CO, USA, 80045.
Department of Surgery, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, USA, 19104.
Am J Surg. 2025 Jun 10;250:116475. doi: 10.1016/j.amjsurg.2025.116475.
Patients with obesity and ESRD experience significant barriers accessing kidney transplantation. Effective weight management is crucial for facilitating access to transplant and improving survival.
A Markov state transition model evaluated the effectiveness of three weight loss interventions: GLP-1 receptor agonist, dual GLP-1/GIP receptor agonist, and sleeve gastrectomy (SG) in morbidly obese ESRD patients. Patients were ineligible for kidney transplantation unless thachieved a BMI ≤35 kg/m.
At 5 years, the model predicted 14.74 % of SG patients received a transplant, compared to 9.06 % of GLP-1/GIP RA patients and 4.83 % of GLP-1 RA patients. SG resulted in more rapid weight loss, with 27.49 % of patients achieving a BMI ≤35 kg/m by 6 months and demonstrated a survival advantage, particularly in patients with higher pre-intervention BMIs.
SG resulted in more patients receiving a kidney compared to treatment with GLP-1 RA and dual GLP-1/GIP RA. While not as effective as SG, dual GLP-1/GIP RA resulted in a substantial number of patients undergoing transplantation and should not be discounted as a promising pharmacologic alternative.
