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Innovative program connects bariatric surgery and kidney transplant access for patients who have obesity and end-stage renal disease

A collaborative study between bariatric and transplant teams has created a viable pathway for patients with obesity who also have end-stage renal disease (ESRD) to become eligible for kidney transplants through bariatric surgery. The study authors explored the outcomes of metabolic and bariatric surgery in ESRD patients and whether the surgery can improve their eligibility for kidney transplants. The postoperative outcomes indicate significant improvements in BMI, hypertension, and diabetes management, enhancing patients’ overall health and transplant viability.

“Obesity is a worsening problem in the United States, significantly impacting transplant eligibility. We established the CORT initiative – a collaborative for obesity research in transplantation – recognizing the urgent need to address this issue, especially in underserved populations who suffer the most from obesity-related diseases,” said corresponding study author Dr Anil Paramesh, professor of surgery, urology, and pediatrics and director of the kidney and pancreas transplant programs at Tulane University School of Medicine. 

Patients with ESRD face many difficulties without a transplant; their only alternative is to prolong life through dialysis, a process that is not only costly and time-intensive but also significantly diminishes quality of life, Paramesh noted. 

The study, conducted between January 2019 and June 2023, followed 183 ESRD patients referred for bariatric surgery, with 36 undergoing weight loss surgery and 10 subsequently receiving kidney transplants. Results showed a 27% reduction in average BMI at the time of transplant, alongside improvements in hypertension and diabetes management. This improvement in the management of comorbid conditions enhanced patients’ overall health and transplant viability.

With obesity being a major cause of transplant exclusion, this collaborative program represents a path forward for patients who previously would be ineligible, Paramesh added, and may help pave the way for increased patient education and access. 

“We’ve seen that bariatric surgery is not just about weight loss; it significantly improves other serious conditions like diabetes, high blood pressure, and sleep apnoea. This approach not only helps in reducing the patients’ weight to a level where they can safely receive a transplant, but also addresses the broader issue of health care disparities, particularly affecting Black and lower-income individuals,” explained Paramesh.

However, the study also faced challenges, including a high drop-off rate of patients unwilling or unable to undergo surgery, and unique postoperative complications such as hypotension. 

“Our findings indicate a pressing need to enhance patient education and support, making sure that potential candidates understand the benefits of weight loss surgery and its role in improving their eligibility for transplant,” Paramesh concluded.

The authors suggest further studies could examine the unique complications ESRD patients may have after weight loss surgery.

The findings were featured in the paper, ‘A Collaborative Approach Between Bariatric and Transplant Surgery Teams Allows a Pathway for Underserved Obese ESRD Patients’, published in the Journal of the American College of Surgeons. To access this paper, please click here (login maybe required)


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