Roux-en-Y gastric bypass is an effective bridge to kidney transplantation: Results from a single center

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Abstract

Body mass index (BMI) > 35-40 kg/m2 is often a contraindication, while Roux-en-Y gastric bypass (RYGB) is performed to enable kidney transplantation. This single-center retrospective study evaluated pre- and post-transplant outcomes of 31 morbidly obese patients with end-stage renal disease having RYGB before kidney transplantation between July 2009 and June 2014. Fourteen RYGB patients were subsequently transplanted. Nineteen recipients not having GB with a BMI ≥ 36 kg/m2 at transplantation were used as historical controls. Mean BMI (±SE) before RYGB was 43.5 ± 0.7 kg/m2 (range: 35.4-50.5 kg/m2); 87.1% (27/31) achieved a BMI < 35 kg/m2. The percentage having improved diabetes/hypertension control was 29.0% (9/31); 25.8% (8/31) had complications (mostly minor) after RYGB. Among transplanted patients, blacks/Hispanics comprised 78.6% (11/14) and 84.2% (16/19) of RYGB and controls; 57.1% (8/14) and 63.2% (12/19) had a (mostly long-standing) pretransplant history of diabetes. While biopsy-proven acute rejection (BPAR) occurred significantly higher among RYGB vs control patients (6/14 vs 3/19, P = .03), patients developing T-cell BPAR were also significantly more likely to have a tacrolimus (TAC) trough level < 4.0 ng/mL within 3 weeks of T-cell BPAR (P = .0007). In Cox's model, the impact of having a TAC level < 4.0 ng/mg remained significant (P = .007) while the effect of RYGB was no longer significant (P = .13). Infections, graft, and patient survival were not significantly different. Despite obvious effectiveness in achieving weight loss, RYGB will need more careful post-transplant monitoring given the observed higher BPAR rate.

Original languageEnglish (US)
JournalClinical Transplantation
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Gastric Bypass
Kidney Transplantation
Body Mass Index
Biopsy
Tacrolimus
Transplants
T-Lymphocytes
Graft Survival
Hispanic Americans
Proportional Hazards Models
Chronic Kidney Failure
Weight Loss
Retrospective Studies
Transplantation
Hypertension

Keywords

  • Kidney transplantation
  • Morbid obesity
  • Roux-en-Y gastric bypass

ASJC Scopus subject areas

  • Transplantation

Cite this

@article{45475954c84140ef9aaa54baa53da6fa,
title = "Roux-en-Y gastric bypass is an effective bridge to kidney transplantation: Results from a single center",
abstract = "Body mass index (BMI) > 35-40 kg/m2 is often a contraindication, while Roux-en-Y gastric bypass (RYGB) is performed to enable kidney transplantation. This single-center retrospective study evaluated pre- and post-transplant outcomes of 31 morbidly obese patients with end-stage renal disease having RYGB before kidney transplantation between July 2009 and June 2014. Fourteen RYGB patients were subsequently transplanted. Nineteen recipients not having GB with a BMI ≥ 36 kg/m2 at transplantation were used as historical controls. Mean BMI (±SE) before RYGB was 43.5 ± 0.7 kg/m2 (range: 35.4-50.5 kg/m2); 87.1{\%} (27/31) achieved a BMI < 35 kg/m2. The percentage having improved diabetes/hypertension control was 29.0{\%} (9/31); 25.8{\%} (8/31) had complications (mostly minor) after RYGB. Among transplanted patients, blacks/Hispanics comprised 78.6{\%} (11/14) and 84.2{\%} (16/19) of RYGB and controls; 57.1{\%} (8/14) and 63.2{\%} (12/19) had a (mostly long-standing) pretransplant history of diabetes. While biopsy-proven acute rejection (BPAR) occurred significantly higher among RYGB vs control patients (6/14 vs 3/19, P = .03), patients developing T-cell BPAR were also significantly more likely to have a tacrolimus (TAC) trough level < 4.0 ng/mL within 3 weeks of T-cell BPAR (P = .0007). In Cox's model, the impact of having a TAC level < 4.0 ng/mg remained significant (P = .007) while the effect of RYGB was no longer significant (P = .13). Infections, graft, and patient survival were not significantly different. Despite obvious effectiveness in achieving weight loss, RYGB will need more careful post-transplant monitoring given the observed higher BPAR rate.",
keywords = "Kidney transplantation, Morbid obesity, Roux-en-Y gastric bypass",
author = "Thomas, {Ian A.} and Gaynor, {Jeffrey J.} and Tameka Joseph and {De La Cruz-Munoz}, Nestor and Junichiro Sageshima and Warren Kupin and Chen, {Linda J.} and Gaetano Ciancio and Burke, {George W.} and Mattiazzi, {Adela D.} and David Roth and Giselle Guerra",
year = "2018",
month = "1",
day = "1",
doi = "10.1111/ctr.13232",
language = "English (US)",
journal = "Clinical Transplantation",
issn = "0902-0063",
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TY - JOUR

T1 - Roux-en-Y gastric bypass is an effective bridge to kidney transplantation

T2 - Results from a single center

AU - Thomas, Ian A.

AU - Gaynor, Jeffrey J.

AU - Joseph, Tameka

AU - De La Cruz-Munoz, Nestor

AU - Sageshima, Junichiro

AU - Kupin, Warren

AU - Chen, Linda J.

AU - Ciancio, Gaetano

AU - Burke, George W.

AU - Mattiazzi, Adela D.

AU - Roth, David

AU - Guerra, Giselle

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Body mass index (BMI) > 35-40 kg/m2 is often a contraindication, while Roux-en-Y gastric bypass (RYGB) is performed to enable kidney transplantation. This single-center retrospective study evaluated pre- and post-transplant outcomes of 31 morbidly obese patients with end-stage renal disease having RYGB before kidney transplantation between July 2009 and June 2014. Fourteen RYGB patients were subsequently transplanted. Nineteen recipients not having GB with a BMI ≥ 36 kg/m2 at transplantation were used as historical controls. Mean BMI (±SE) before RYGB was 43.5 ± 0.7 kg/m2 (range: 35.4-50.5 kg/m2); 87.1% (27/31) achieved a BMI < 35 kg/m2. The percentage having improved diabetes/hypertension control was 29.0% (9/31); 25.8% (8/31) had complications (mostly minor) after RYGB. Among transplanted patients, blacks/Hispanics comprised 78.6% (11/14) and 84.2% (16/19) of RYGB and controls; 57.1% (8/14) and 63.2% (12/19) had a (mostly long-standing) pretransplant history of diabetes. While biopsy-proven acute rejection (BPAR) occurred significantly higher among RYGB vs control patients (6/14 vs 3/19, P = .03), patients developing T-cell BPAR were also significantly more likely to have a tacrolimus (TAC) trough level < 4.0 ng/mL within 3 weeks of T-cell BPAR (P = .0007). In Cox's model, the impact of having a TAC level < 4.0 ng/mg remained significant (P = .007) while the effect of RYGB was no longer significant (P = .13). Infections, graft, and patient survival were not significantly different. Despite obvious effectiveness in achieving weight loss, RYGB will need more careful post-transplant monitoring given the observed higher BPAR rate.

AB - Body mass index (BMI) > 35-40 kg/m2 is often a contraindication, while Roux-en-Y gastric bypass (RYGB) is performed to enable kidney transplantation. This single-center retrospective study evaluated pre- and post-transplant outcomes of 31 morbidly obese patients with end-stage renal disease having RYGB before kidney transplantation between July 2009 and June 2014. Fourteen RYGB patients were subsequently transplanted. Nineteen recipients not having GB with a BMI ≥ 36 kg/m2 at transplantation were used as historical controls. Mean BMI (±SE) before RYGB was 43.5 ± 0.7 kg/m2 (range: 35.4-50.5 kg/m2); 87.1% (27/31) achieved a BMI < 35 kg/m2. The percentage having improved diabetes/hypertension control was 29.0% (9/31); 25.8% (8/31) had complications (mostly minor) after RYGB. Among transplanted patients, blacks/Hispanics comprised 78.6% (11/14) and 84.2% (16/19) of RYGB and controls; 57.1% (8/14) and 63.2% (12/19) had a (mostly long-standing) pretransplant history of diabetes. While biopsy-proven acute rejection (BPAR) occurred significantly higher among RYGB vs control patients (6/14 vs 3/19, P = .03), patients developing T-cell BPAR were also significantly more likely to have a tacrolimus (TAC) trough level < 4.0 ng/mL within 3 weeks of T-cell BPAR (P = .0007). In Cox's model, the impact of having a TAC level < 4.0 ng/mg remained significant (P = .007) while the effect of RYGB was no longer significant (P = .13). Infections, graft, and patient survival were not significantly different. Despite obvious effectiveness in achieving weight loss, RYGB will need more careful post-transplant monitoring given the observed higher BPAR rate.

KW - Kidney transplantation

KW - Morbid obesity

KW - Roux-en-Y gastric bypass

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