Obesity treatment as a bridge to solid organ transplantation: A comparison of bariatric surgery to medical therapy

Background

Organ transplant is a rapidly growing area of medicine, with over 42,800 organ transplants occurring in 2022.[1] Obesity complicates the transplant surgery process; historically, the only available treatment for patients with both severe obesity and end-organ damage requiring transplant was bariatric surgery. Glucagon-like peptide-1 (GLP-1) and dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) agonists (such as semaglutide and tirzepatide, respectively) may offer a non-surgical alternative to weight management prior to transplant surgery.

Methods

This descriptive case series utilized retrospective chart review to compare peri-transplant weight loss in individuals treated with bariatric surgery alone, GLP-1 or GLP-1/GIP medication without surgical intervention, and GLP-1 or GLP-1/GIP medication with surgical intervention. Nineteen (N = 19) patients pursuing kidney transplant met inclusion criteria. Primary outcomes of interest in each group were median weight loss, total weight loss percent, and portion of individuals who met the BMI cut-off for transplantation following the intervention.

Results

Individuals treated with tirzepatide (n = 9) demonstrated 8 % less weight loss than the surgical-intervention group, and 77.8 % (n = 7) met BMI cutoff for transplant after treatment. Among patients treated with semaglutide (n = 4), 50 % (n = 2) met BMI cutoff for transplant. In the bariatric-surgery only group, 66.7 % (n = 2) met the BMI cutoff for transplant. Among those who received both bariatric surgery and GLP-1 medication (n = 3), all met the BMI cutoff for transplant.

Conclusions

This descriptive case series demonstrates that the current generation of weight loss medications produce a degree of weight loss comparable to bariatric surgery; this is particularly relevant to individuals with obesity who are pursuing organ transplant. Conclusions are limited due to the small, retrospective, and observational nature of this study; however, the results support the hypothesis that medications could revolutionize the organ transplant process by providing a reasonable non-surgical weight loss option for individuals with obesity. Further study with a larger, prospective randomized trial is needed to fully evaluate the viability of utilizing anti-obesity medications for this unique clinical indication.