Roddy Kevin L, Greenwald Matthew R, Hollman Nicholas, Dorand Madisen F, Richards Jesse R
University of Oklahoma, School of Community Medicine, USA.
Obes Pillars. 2025 Jul 26;16:100199. doi: 10.1016/j.obpill.2025.100199. eCollection 2025 Dec.
Organ transplant is a rapidly growing area of medicine, with over 42,800 organ transplants occurring in 2022.[1] Obesity complicates the transplant surgery process; historically, the only available treatment for patients with both severe obesity and end-organ damage requiring transplant was bariatric surgery. Glucagon-like peptide-1 (GLP-1) and dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) agonists (such as semaglutide and tirzepatide, respectively) may offer a non-surgical alternative to weight management prior to transplant surgery.
This descriptive case series utilized retrospective chart review to compare peri-transplant weight loss in individuals treated with bariatric surgery alone, GLP-1 or GLP-1/GIP medication without surgical intervention, and GLP-1 or GLP-1/GIP medication with surgical intervention. Nineteen (N = 19) patients pursuing kidney transplant met inclusion criteria. Primary outcomes of interest in each group were median weight loss, total weight loss percent, and portion of individuals who met the BMI cut-off for transplantation following the intervention.
Individuals treated with tirzepatide (n = 9) demonstrated 8 % less weight loss than the surgical-intervention group, and 77.8 % (n = 7) met BMI cutoff for transplant after treatment. Among patients treated with semaglutide (n = 4), 50 % (n = 2) met BMI cutoff for transplant. In the bariatric-surgery only group, 66.7 % (n = 2) met the BMI cutoff for transplant. Among those who received both bariatric surgery and GLP-1 medication (n = 3), all met the BMI cutoff for transplant.
This descriptive case series demonstrates that the current generation of weight loss medications produce a degree of weight loss comparable to bariatric surgery; this is particularly relevant to individuals with obesity who are pursuing organ transplant. Conclusions are limited due to the small, retrospective, and observational nature of this study; however, the results support the hypothesis that medications could revolutionize the organ transplant process by providing a reasonable non-surgical weight loss option for individuals with obesity. Further study with a larger, prospective randomized trial is needed to fully evaluate the viability of utilizing anti-obesity medications for this unique clinical indication.
器官移植是医学领域中一个快速发展的领域，2022年进行了超过42,800例器官移植手术。[1]肥胖使移植手术过程变得复杂；从历史上看，对于严重肥胖且终末器官受损需要移植的患者，唯一可用的治疗方法是减肥手术。胰高血糖素样肽-1（GLP-1）和双重GLP-1/葡萄糖依赖性促胰岛素多肽（GIP）激动剂（分别如司美格鲁肽和替尔泊肽）可能为移植手术前的体重管理提供一种非手术替代方案。
本描述性病例系列采用回顾性病历审查，比较单独接受减肥手术、未进行手术干预仅使用GLP-1或GLP-1/GIP药物治疗以及接受GLP-1或GLP-1/GIP药物联合手术干预的个体在移植前后的体重减轻情况。19名寻求肾移植的患者符合纳入标准。每组关注的主要结局指标为体重减轻中位数、总体重减轻百分比以及干预后达到移植BMI临界值的个体比例。
接受替尔泊肽治疗的个体（n = 9）体重减轻比手术干预组少8%，治疗后77.8%（n = 7）达到移植的BMI临界值。在接受司美格鲁肽治疗的患者中（n = 4），50%（n = 2）达到移植的BMI临界值。仅接受减肥手术组中，66.7%（n = 2）达到移植的BMI临界值。在接受减肥手术和GLP-1药物联合治疗的患者中（n = 3），所有人都达到了移植的BMI临界值。
本描述性病例系列表明，当前一代减肥药物产生的体重减轻程度与减肥手术相当；这对正在寻求器官移植的肥胖个体尤为重要。由于本研究规模小、具有回顾性和观察性，结论有限；然而，结果支持这样的假设，即药物可以通过为肥胖个体提供合理的非手术减肥选择，彻底改变器官移植过程。需要进行更大规模的前瞻性随机试验进一步研究，以全面评估使用抗肥胖药物治疗这一独特临床适应症的可行性。
