Medical and Surgical Weight Loss as a Pathway to Renal Transplant Listing.

IF 1 4区医学 Q3 SURGERY

American Surgeon Pub Date : 2025-01-01 Epub Date: 2024-08-16 DOI:10.1177/00031348241275714

Jason M Samuels, Wayne English, Kelly A Birdwell, Irene D Feurer, David Shaffer, Sunil K Geevarghese, Seth J Karp

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引用次数: 0

Abstract

Purpose: Severe obesity is a barrier to listing for kidney transplantation due to concern for poor outcomes. This study aims to compare bariatric surgery with medical weight loss as a means of achieving weight loss and subsequent listing for renal transplant. We hypothesize that bariatric surgery will induce greater frequency of listing for transplant within 18 months of study initiation.

Materials and methods: We performed a randomized study of metabolic bariatric surgery (MBS) vs medical weight loss (MM) in patients on dialysis with a body mass index (BMI) of 40-55 kg/m². The primary outcome was suitability for renal transplant within 18 months of initiating treatment. Secondary outcomes included weight loss, mortality, and complications.

Results: Twenty patients enrolled, only 9 (5 MBS, 4 MM) received treatment. Treated groups did not differ in age, gender, or race (P ≥ .44). There was no statistically significant difference in the primary endpoint: 2 MBS (40%) and 1 MM (25%) listed for transplant ≤18 months (P = 1.00). With additional time, 100% MBS and 25% MM patients achieved listing status (P = .048); 100% of MBS and 0 MM received kidney transplants to date (P = .008). Weight, weight loss, and BMI trajectories differed between the groups (P ≤ .002). One death from COVID-19 occurred in the MM group, and 1 MBS patient had a myocardial infarction 3.75 years after baseline evaluation.

Conclusion: These results suggest MBS is superior to MM in achieving weight loss prior to listing for kidney transplantation. Larger studies are needed to ensure the safety profile is acceptable in patients with ESRD undergoing bariatric surgery.

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药物和手术减肥是肾移植手术的必经之路。

目的：严重肥胖是肾移植的一个障碍，因为人们担心肥胖会带来不良后果。本研究旨在比较减肥手术和药物减肥作为实现体重减轻的一种手段，以及随后肾移植的上市情况。我们假设，减肥手术将在研究开始后的 18 个月内促使更多的患者被列入肾移植名单：我们对体重指数（BMI）为 40-55 kg/m2 的透析患者进行了代谢减肥手术（MBS）与药物减肥（MM）的随机研究。主要研究结果是开始治疗后 18 个月内是否适合肾移植。次要结果包括体重下降、死亡率和并发症：20名患者接受了治疗，只有9名（5名MBS，4名MM）接受了治疗。治疗组在年龄、性别或种族方面没有差异（P ≥ 0.44）。主要终点：2 名 MBS（40%）和 1 名 MM（25%）在 18 个月内接受移植（P = 1.00），差异无统计学意义。随着时间的延长，100% 的 MBS 和 25% 的 MM 患者达到了上市条件（P = .048）；迄今为止，100% 的 MBS 和 0 名 MM 接受了肾移植（P = .008）。两组患者的体重、体重减轻和体重指数轨迹存在差异（P ≤ .002）。MM组有一人死于COVID-19，1名MBS患者在基线评估3.75年后发生心肌梗死：这些结果表明，在肾移植手术前减轻体重方面，MBS优于MM。需要进行更大规模的研究，以确保接受减肥手术的 ESRD 患者能够接受其安全性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Surgeon 医学-外科

CiteScore

1.40

自引率

0.00%

发文量

623

期刊介绍： The American Surgeon is a monthly peer-reviewed publication published by the Southeastern Surgical Congress. Its area of concentration is clinical general surgery, as defined by the content areas of the American Board of Surgery: alimentary tract (including bariatric surgery), abdomen and its contents, breast, skin and soft tissue, endocrine system, solid organ transplantation, pediatric surgery, surgical critical care, surgical oncology (including head and neck surgery), trauma and emergency surgery, and vascular surgery.