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Improved odds

Sleeve gastrectomy improves chances of organ transplant

Chances of a morbidly obese patient getting a kidney transplant are improved after gastrectomy. Photo: iStockphoto
Paper follows 26 morbidly obese patients with end-stage organ failure who were accepted for kidney/liver transplant after gastrectomy
Eight out of 26 patients have already received transplants
Study claimed to be largest to examine the impact of sleeve surgery on pre-transplant patients

Morbidly obese patients with end-stage organ failure may increase their chances of successful organ transplantation by undergoing laparascopic sleeve gastrectomy, according to a new study presented at the ASMBS’ 29th annual meeting in San Diego.

“Sleeve gastrectomy may be performed safely in carefully selected morbidly obese patients with impending organ failure and the significant weight loss they achieve may make them more suitable candidates for transplantation.” Lead study author Matthew Yi-Chih Lin

The paper, ‘Laparoscopic Sleeve Gastrectomy Is Safe And Efficacious For Pre-Transplant Candidates’, examined 26 patients with an average age of 57, who presented with end-stage kidney disease (n=6) and severely compromised liver function (n=20).

Within nine months of surgery, six patients had liver transplants, one patient had a kidney transplant, one had a combined liver and kidney transplant, and one patient’s kidney function improved to the point that he was taken off the transplant list. 16 more patients are currently on the transplant list and have lost enough weight to qualify for transplantation.

The remaining patient in the study died four years after surgery while waiting for a transplant. There were six complications among the group.

Researchers say most US centres will not perform organ transplantation in patients with BMIs of more than 35-40. The average starting BMI of the patients in the study was 48.3.

“This study suggests sleeve gastrectomy may be performed safely in carefully selected morbidly obese patients with impending organ failure and the significant weight loss they achieve may make them more suitable candidates for transplantation,” said lead study author Matthew Yi-Chih Lin, MD, a bariatric surgeon at the UCSF School of Medicine.

While the study had a relatively low number of participants, the study authors claim that it is the largest study to examine the impact of gastric sleeve surgery on pre-transplant patients.

The patients in the study lost 17% of their excess weight at one month, 26% at three months, 50% at 12 months and 66% at two years. As well as the weight loss, seven of the 13 patients with type 2 diabetes showed complete resolution of the disease; one further patient was able to significantly reduce insulin use.

According to the US government figures, there were 16,898 kidney transplant procedures in 2010, with 94,598 people on the waiting list. Liver transplants numbered 6,291, with 16,954 people on the waiting list. About one-third of people on organ transplantation waiting lists are obese and as many as 15% are morbidly obese.

The surgeons in the study choose sleeve gastrectomy over other methods because the procedure avoids implantation of foreign bodies like gastric bands in immunosupporessed patients. It also maintains endoscopic access to the biliary system.

The ASMBS is currently in a disagreement with Centers for Medicaid and Medicare Services (CMS) after the latter proposed coverage for sleeve gastrectomy only as part of a randomised control trial, ruling that currently available evidence is insufficient to support its widespread adoption. The ASMBS, among other medical groups, responded that the CMS did not consider all relevant evidence when making their decision.

Co-authors for the study include Ankit Sarin, MD, Mehdi Tavakol, MD, Shadee M. Amirkiai, BS, Stanley J. Rogers, MD, Jonathan T. Carter, MD, Andrew M. Posselt, MD, PhD.

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