Patients with obesity and kidney failure may be new candidates for kidney transplants

A viable pathway for patients with obesity.

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Transplantation is frequently not an option for people with End Stage Renal Disease (ESRD) because of a high Body Mass Index (BMI). This increases the cost of maintaining people on dialysis and exacerbates already-existing racial and economic inequities. Metabolic Bariatric Surgery (MBS) is not easily available for these patients.

For those with obesity and end-stage renal disease (ESRD), a collaborative study conducted by specialists in both bariatric and transplant surgery opens up new options. The study looked into the potential effects of metabolic and bariatric surgery on kidney transplant prospects for patients with end-stage renal disease (ESRD).

Between January 2019 and June 2023, the researchers cared for 183 patients with end-stage renal disease (ESRD) who were being evaluated for bariatric surgery. Thirty-six of them had weight-loss surgery, and ten of them subsequently got kidney transplants.

The average body mass index (BMI) decreased by 27% by the time of transplant, and diabetes and hypertension were better managed, according to the findings. Patients’ advancements in the management of other medical conditions improved patients’ general health and made them better candidates for transplants.

Patients who were previously considered obese and not eligible for transplants now have hope thanks to this cooperative approach, which may also improve education and treatment access for others facing similar challenges.

Corresponding study author Anil Paramesh, MD, MBA, FACS, professor of surgery, urology, and pediatrics and director of the kidney and pancreas transplant programs at Tulane University School of Medicine, said, “We’ve seen that bariatric surgery is not just about weight loss; it significantly improves other serious conditions like diabetes, high blood pressure, and sleep apnea. This approach not only helps in reducing the patients’ weight to a level where they can safely receive a transplant but also addresses the broader issue of health care disparities, particularly affecting Black and lower-income individuals.”

Challenges for the study included a large number of patients who chose not to have surgery or were unable to do so, as well as unique post-surgical problems like hypotension.

According to Dr. Paramesh, enhancing patient education and support is crucial to ensuring prospective candidates understand the benefits of weight loss surgery and how it affects eligibility for transplants.

The authors suggest that future studies examine the specific issues that individuals with end-stage renal disease (ESRD) may have following weight loss surgery.

Journal Reference:

  1. Levy S, Attia A, Omar M, et al. A Collaborative Approach Between Bariatric and Transplant Surgery Teams Allows a Pathway for Underserved Obese ESRD Patients. Journal of the American College of Surgeons, 2024. DOI:10.1097/XCS.0000000000000962
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