Sleeve gastrectomy versus GLP-1 agonist to improve kidney transplant access in end-stage renal disease patients with obesity: a decision analysis.

Abstract

Background: Obesity can be a barrier to accessing kidney transplantation as there is significant variability in body mass index (BMI) criteria among transplant centers. Effective weight loss strategies are crucial for improving access to kidney transplantation in the end-stage renal disease (ESRD) population with obesity.

Objectives: To estimate access to kidney transplantation following diet and exercise, sleeve gastrectomy (SG), and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in this population.

Setting: University hospital, United States.

Methods: A decision-analytic Markov state transition model was created to simulate the outcomes of ESRD patients with obesity who were ineligible for kidney transplantation unless they achieved a BMI <35 kg/m². Base case patients were defined as a 45-year-old patient with a preintervention BMI of 45 kg/m². Model inputs were obtained from literature review.

Results: SG resulted in 14% of patients receiving kidney transplantation at 10 years, compared to 2.5% of patients in the GLP-1 RA group, and <1% of patients with diet and exercise. Upon sensitivity analysis, SG demonstrated a survival advantage over both diet and exercise and GLP-1 RAs above a BMI of 34.4 kg/m² and 37.5 kg/m², respectively, assuming 100% compliance with diet and exercise or medication.

Conclusions: SG improves access to kidney transplantation compared to diet and exercise and GLP-1 RAs. As new obesity medications continue to be developed and increase in popularity, the risks and benefits of these therapies should be compared to currently available weight loss therapies in an effort to optimize obesity management in this population.