1982-P: Laparoscopic Sleeve Gastrectomy as Bridge to Kidney Transplantation: Pilot Study in Subjects with Renal Failure and Obesity

Obesity and associated metabolic complications are established risk factors for the development and progression of chronic kidney disease; however, BMI (body mass index)>35 kg/m² is a contraindication for kidney transplantation. The aim of our study was to reduce excess body weight via laparoscopic sleeve gastrectomy (LSG) in obese patients with end-stage renal disease (ESRD) in order for them to become eligible for the transplantation program.

Subjects with ESRD undergoing hemodialysis or peritoneal dialysis and BMI>35kg/m² without serious comorbidities were included into the study. Anthropometric and biochemical parameters were measured before and 1, 3 and 6 months after LSG.

In the thus far enrolled 7 subjects (6 females, aged 47.6 ± 9.6 years) LSG resulted in improved body weight (118.0 ± 17.6 vs. 107.5 ± 14.5 vs. 105.5 ± 14.4 vs. 99.5 ± 10.7 kg for baseline vs. 1 vs. 3 vs. 6 months, p<0.001) and BMI (42.5 ± 3.8 vs. 38.6 ± 3.2 vs. 37.4 ± 2.8 vs. 37.0 ± 3.1 kg/m² for baseline vs. 1 vs. 3 vs. 6 months, p<0.001) with 3 subjects achieving target BMI<35 kg/m² 1-6 months after LSG enabling their inclusion in the kidney transplantation waiting list. Weight loss was accompanied by significant decrease of systolic (160.0 ± 25.0 vs. 128.7 ± 31.2 mmHg, p=0.042) and diastolic (99.0 ± 13.6 vs. 75.5 ± 12.0 mmHg, p=0.022) blood pressure with antihypertensive medication being reduced in 2 subjects. The only subjects with diabetes mellitus (type 1) showed improvement in fasting glucose (15.8 vs. 9.3 mmol/l) and HbA_1c (84 vs. 68 mmol/mol) and a 25% reduction of prandial insulin dose 1 month after LSG. No peri- or postoperative complications have been observed to date.

To conclude, our pilot data suggest LSG to be an efficient and safe method to achieve the necessary weight reduction enabling renal transplantation in subjects with renal failure and higher degrees of obesity.