Addressing Morbid Obesity as a Barrier to Renal Transplantation With Laparoscopic Sleeve Gastrectomy

Morbid obesity is a barrier to renal transplantation and is inadequately addressed by medical therapy. We present results of a prospective evaluation of laparoscopic sleeve gastrectomy (LSG) for patients failing to achieve significant weight loss with medical therapy. Over a 25-month period, 52 obese renal transplant candidates meeting NIH guidelines for metabolic surgery underwent LSG. Mean age was 50.0 +/- 10.0 years with an average preoperative BMI of 43.0 +/- 5.4 kg/m(2) (range 35.8-67.7 kg/m(2)). Follow-up after LSG was 220 +/- 152 days (range 26-733 days) with last BMI of 36.3 +/- 5.3 kg/m(2) (range 29.2-49.8kg/m(2)) with 29 (55.8%) patients achieving goal BMI of <35 kg/m(2) at 92 +/- 92 days (range 13-420 days). The mean percentage of excess weight loss (%EWL) was 32.1 +/- 17.6% (range 6.7-93.8%). A segmented regression model was used to compare medical therapy versus LSG. This revealed a statistically significant increase in the BMI reduction rate (0.3 kg/m(2)/month versus 1.1 kg/m(2)/month, p < 0.0001). Patients also experienced a 40.9% decrease in anti-hypertensive medications (p < 0.001) and a 49.7% decrease in total daily insulin dose (p < 0.001). LSG is a safe and effective means for addressing obesity in kidney transplant candidates in the context of a multidisciplinary approach.