Sleeve gastrectomy enables simultaneous pancreas and kidney transplantation in severely obese recipients.
bariatric surgery
laparoscopic sleeve gastrectomy
simultaneous pancreas and kidney transplantation
Journal
Clinical transplantation
ISSN: 1399-0012
Titre abrégé: Clin Transplant
Pays: Denmark
ID NLM: 8710240
Informations de publication
Date de publication:
03 2021
03 2021
Historique:
revised:
02
12
2020
received:
08
10
2020
accepted:
09
12
2020
pubmed:
20
12
2020
medline:
2
7
2021
entrez:
19
12
2020
Statut:
ppublish
Résumé
Obesity adversely affects wait-listing and precludes patients with concomitant end-stage renal disease and type 1 diabetes mellitus from getting a simultaneous pancreas and kidney transplantation (SPK). To analyze safety and efficacy of laparoscopic sleeve gastrectomy (LSG) before SPK in severely obese type I diabetics. We assessed weight curve, complications, and graft function of three patients who underwent LSG before SPK. LSG was uneventful in all patients. Body mass index dropped from 38.4 (range 35.7 - 39.9) before LSG to 28.5 (26.8 - 30.9) until SPK, with a mean loss of 25.8% (22.4 - 32.3). Interval between LSG and SPK was 364.3 (173 - 587) days. Pancreas and kidney graft function was excellent, with 100% insulin-free and dialysis-free survival over a mean follow-up of 3.6 (2.9 - 4.5) years. A1C dropped from 7% (6.3 - 8.2) before LSG to 4.9% (4.7 - 5.3) and 4.8% (4.5 - 5.1) 1 and 2 years after SPK, respectively. LSG before SPK is safe and effective to enable severely obese type I diabetics to receive a lifesaving transplant. This is the first study analyzing the role of bariatric surgery before simultaneous pancreas and kidney transplantation.
Sections du résumé
BACKGROUND
Obesity adversely affects wait-listing and precludes patients with concomitant end-stage renal disease and type 1 diabetes mellitus from getting a simultaneous pancreas and kidney transplantation (SPK).
OBJECTIVE
To analyze safety and efficacy of laparoscopic sleeve gastrectomy (LSG) before SPK in severely obese type I diabetics.
METHODS
We assessed weight curve, complications, and graft function of three patients who underwent LSG before SPK.
RESULTS
LSG was uneventful in all patients. Body mass index dropped from 38.4 (range 35.7 - 39.9) before LSG to 28.5 (26.8 - 30.9) until SPK, with a mean loss of 25.8% (22.4 - 32.3). Interval between LSG and SPK was 364.3 (173 - 587) days. Pancreas and kidney graft function was excellent, with 100% insulin-free and dialysis-free survival over a mean follow-up of 3.6 (2.9 - 4.5) years. A1C dropped from 7% (6.3 - 8.2) before LSG to 4.9% (4.7 - 5.3) and 4.8% (4.5 - 5.1) 1 and 2 years after SPK, respectively.
CONCLUSION
LSG before SPK is safe and effective to enable severely obese type I diabetics to receive a lifesaving transplant. This is the first study analyzing the role of bariatric surgery before simultaneous pancreas and kidney transplantation.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e14197Informations de copyright
© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Références
Curran SP, Famure O, Li Y, Kim SJ. Increased recipient body mass index is associated with acute rejection and other adverse outcomes after kidney transplantation. Transplantation. 2014;97:64-70.
Cannon RM, Jones CM, Hughes MG, Eng M, Marvin MR. The impact of recipient obesity on outcomes after renal transplantation. Ann Surg. 2013;257:978-984.
Lynch RJ, Ranney DN, Shijie C, Lee DS, Samala N, Englesbe MJ. Obesity, surgical site infection, and outcome following renal transplantation. Ann Surg. 2009;250:1014-1020.
Spengler EK, O'Leary JG, Te HS, et al. Liver transplantation in the obese cirrhotic patient. Transplantation. 2017;101:2288-2296.
Rana A, Gruessner A, Agopian VG, et al. Survival benefit of solid-organ transplant in the United States. JAMA Surg. 2015;150:252-259.
White SA, Shaw JA, Sutherland DE. Pancreas transplantation. Lancet. 2009;373:1808-1817.
Lehmann R, Graziano J, Brockmann J, et al. Glycemic control in simultaneous islet-kidney versus pancreas-kidney transplantation in type 1 diabetes: a prospective 13-year follow-up. Diabetes Care. 2015;38:752-759.
Patterson EJ, Urbach DR, Swanstrom LL. A comparison of diet and exercise therapy versus laparoscopic Roux-en-Y gastric bypass surgery for morbid obesity: a decision analysis model. J Am Coll Surg. 2003;196:379-384.
Adams TD, Davidson LE, Litwin SE, et al. Weight and Metabolic Outcomes 12 Years after Gastric Bypass. N Engl J Med. 2017;377:1143-1155.
Cohen JB, Lim MA, Tewksbury CM, et al. Bariatric surgery before and after kidney transplantation: long-term weight loss and allograft outcomes. Surg Obes Relat Dis. 2019;15:935-941.
Kienzl-Wagner K, Weissenbacher A, Gehwolf P, Wykypiel H, Ofner D, Schneeberger S. Laparoscopic sleeve gastrectomy: gateway to kidney transplantation. Surg Obes Relat Dis. 2017;13:909-915.
Kim Y, Jung AD, Dhar VK, et al. Laparoscopic sleeve gastrectomy improves renal transplant candidacy and posttransplant outcomes in morbidly obese patients. Am J Transplant. 2018;18:410-416.
Takata MC, Campos GM, Ciovica R, et al. Laparoscopic bariatric surgery improves candidacy in morbidly obese patients awaiting transplantation. Surg Obes Relat Dis. 2008;4(2):159-164; discussion 64-5.
Nesher E, Mor E, Shlomai A, et al. Simultaneous liver transplantation and sleeve gastrectomy: prohibitive combination or a necessity? Obes Surg. 2017;27:1387-1390.
Zamora-Valdes D, Watt KD, Kellogg TA, et al. Long-term outcomes of patients undergoing simultaneous liver transplantation and sleeve gastrectomy. Hepatology (Baltimore, MD). 2018;68:485-495.
Heimbach JK, Watt KD, Poterucha JJ, et al. Combined liver transplantation and gastric sleeve resection for patients with medically complicated obesity and end-stage liver disease. Am J Transplant. 2013;13:363-368.
Porubsky M, Powelson JA, Selzer DJ, et al. Pancreas transplantation after bariatric surgery. Clin Transplant. 2012;26:E1-6.
Salminen P, Helmio M, Ovaska J, et al. Effect of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Roux-en-Y Gastric Bypass on Weight Loss at 5 Years Among Patients With Morbid Obesity: The SLEEVEPASS Randomized Clinical Trial. JAMA. 2018;319:241-254.
Peterli R, Wolnerhanssen BK, Peters T, et al. Effect of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Roux-en-Y Gastric Bypass on Weight Loss in Patients With Morbid Obesity: The SM-BOSS Randomized Clinical Trial. JAMA. 2018;319:255-265.
Peterli R, Wolnerhanssen BK, Vetter D, et al. Laparoscopic Sleeve Gastrectomy Versus Roux-Y-Gastric Bypass for Morbid Obesity-3-Year Outcomes of the Prospective Randomized Swiss Multicenter Bypass Or Sleeve Study (SM-BOSS). Ann Surg. 2017;265:466-473.
Greenblatt HK, Greenblatt DJ. Altered drug disposition following bariatric surgery: a research challenge. Clin Pharmacokinet. 2015;54:573-579.
Padwal R, Brocks D, Sharma AM. A systematic review of drug absorption following bariatric surgery and its theoretical implications. Obes Rev. 2010;11:41-50.
Rogers CC, Alloway RR, Alexander JW, Cardi M, Trofe J, Vinks AA. Pharmacokinetics of mycophenolic acid, tacrolimus and sirolimus after gastric bypass surgery in end-stage renal disease and transplant patients: a pilot study. Clin Transplant. 2008;22:281-291.
Levey AS, Stevens LA, Schmid CH, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150:604-612.
Levey AS, Coresh J, Greene T, et al. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med. 2006;145:247-254.
Deitel M, Gawdat K, Melissas J. Reporting weight loss 2007. Obes Surg. 2007;17:565-568.
Brethauer SA, Kim J, el Chaar M, et al. Standardized outcomes reporting in metabolic and bariatric surgery. Surg Obes Relat Dis. 2015;11:489-506.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205-213.
Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187-196.
Slankamenac K, Graf R, Barkun J, Puhan MA, Clavien PA. The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg. 2013;258:1-7.
Slankamenac K, Nederlof N, Pessaux P, et al. The comprehensive complication index. Ann Surg. 2014;260(5):757-763; discussion 62-3.
Clavien PA, Vetter D, Staiger RD, et al. The Comprehensive Complication Index (CCI(R)): Added Value and Clinical Perspectives 3 Years "Down the Line". Ann Surg. 2017;265:1045-1050.
Bédat B, Niclauss N, Jannot AS, et al. Impact of recipient body mass index on short-term and long-term survival of pancreatic grafts. Transplantation. 2015;99:94-99.
Sampaio MS, Reddy PN, Kuo HT, et al. Obesity was associated with inferior outcomes in simultaneous pancreas kidney transplant. Transplantation. 2010;89:1117-1125.
Hanish SI, Petersen RP, Collins BH, et al. Obesity predicts increased overall complications following pancreas transplantation. Transplant Proc. 2005;37:3564-3566.
Laurence JM, Marquez MA, Bazerbachi F, et al. Optimizing pancreas transplantation outcomes in obese recipients. Transplantation. 2015;99:1282-1287.
Aminian A, Zajichek A, Arterburn DE, et al. Association of metabolic surgery with major adverse cardiovascular outcomes in patients with type 2 diabetes and obesity. JAMA. 2019;322(13):1271.
Bueter M, Ahmed A, Ashrafian H, le Roux CW. Bariatric surgery and hypertension. Surg Obes Relat Dis. 2009;5:615-620.
King WC, Chen JY, Belle SH, et al. Change in pain and physical function following bariatric surgery for severe obesity. JAMA. 2016;315:1362-1371.
Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric Surgery versus Intensive Medical Therapy for Diabetes - 5-Year Outcomes. N Engl J Med. 2017;376:641-651.
Cohen RV, Pereira TV, Aboud CM, et al. Effect of gastric bypass vs best medical treatment on early-stage chronic kidney disease in patients with type 2 diabetes and obesity. JAMA Surg. 2020;155(8):e200420.
Cohen JB, Tewksbury CM, Torres Landa S, Williams NN, Dumon KR. National postoperative bariatric surgery outcomes in patients with chronic kidney disease and end-stage kidney disease. Obes Surg. 2019;29:975-982.
Boggi U, Signori S, Vistoli F, et al. Laparoscopic robot-assisted pancreas transplantation: first world experience. Transplantation. 2012;93:201-206.
Spaggiari M, Tulla KA, Okoye O, et al. The utility of robotic assisted pancreas transplants - a single center retrospective study. Transplant Int. 2019;32:1173-1181.
Monroy-Cuadros M, Salazar A, Yilmaz S, McLaughlin K. Bladder vs enteric drainage in simultaneous pancreas-kidney transplantation. Nephrol Dial Transplant. 2006;21:483-487.