Bariatric surgery
can lessen transplant complications due to excess weight.
Determining how safe it is to have lap band surgery after a kidney transplant is a complicated question. There is little research concerning kidney transplant patients and bariatric surgery.
That’s why the Saint Louis University Center for Outcomes Research did a review of the evidence at hand.
The St. Louis researchers conducted a review of kidney transplant candidates to determine those that had bariatric surgery and what their outcomes were. They looked at Medicare billing claims from 1991 to 2004 to check out the effects of bariatric surgery on 188 kidney transplant patients: those that had been approved for transplant and were waiting; those that were on a waitlist for approval for a kidney transplant and those that had bariatric surgery after a kidney transplant.
Why Consider Bariatric Surgery
Obese people are less likely to be chosen as organ recipients.
In terms of morbidly obese patients, bariatric surgery works. Bariatric surgery has been recommended in a National Institutes of Health Consensus Conference for cardiomyopathy, diabetes and sleep apnea: all obesity-related conditions.
The St. Louis researchers determined that of the 188 cases of kidney transplant candidates and kidney transplant recipients; 97.3 percent also had diagnoses for obesity. Obesity is a common symptom among kidney transplant patients and this added weight increases the risk of death and complications after transplant surgery.
Not only does such excess weight complicate surgery, the St. Louis researchers report that obese people are less likely to be considered for transplants and more likely to be passed over when a kidney transplant becomes available. The scientists theorize that bariatric surgery before a kidney transplant increases the odds that the patient will get a transplant.
Kidney Transplant Concerns
Altering medication levels can improve outcomes for kidney transplant patients.
Some doctors are concerned that bariatric surgery can affect whether or not a transplanted kidney is ultimately rejected. The researchers found just one such case of organ rejection and in three other cases, doctors had to raise immunosuppressant drug intake. They also found six successful cases of bariatric surgery done on pre- and post-implant patients.
The St. Louis researchers also point out that the majority of the bariatric surgeries up until 2004 used open surgical techniques. Open surgery poses more overall risk and risk of infection in transplant patients taking immunosuppressants. Today, laparoscopic surgery such as lap band surgery is a less risky option.
Increased Risk of Death
Immunosuppressant drugs can make surgical infection more likely
After 30 days, the mortality rate after bariatric surgery for listed and transplanted patients was 3.5%. Another 3.5% of the patients died after transplant surgery. There were no deaths in the wait-list patients after 90 days. From 31 to 90 days after the surgery, mortality rates were 0 to 3.5%.
The causes of death were myocardial infarction, cardiac arrhythmia and septicemia.
Although this number isn’t negligible, the researchers said that it was comparable to mortality rates among patients without kidney disease. They also believe advances in surgical technique and the lessons about altering levels of immunosuppressant drugs could lessen this number.
Historical Cases
Laparoscopic techniques are less invasive than open surgery.
The first description of bariatric surgery among obese kidney transplant patients was in 1996. The group now includes nine pre-transplant patients and ten post-transplant patients who have all had bariatric surgery without death or organ rejection.
Six cases of lap band surgery were done in kidney transplant patients and wait-listers from 2000 to 2006. There were some complications in the transplant patients as far as the band moving and/or eroding, but there were no deaths.
Weight Loss
Bariatric and transplant surgeries can give a new lease on life.
In patients without kidney disease, bariatric surgery often results in excess body weight loss (EBWL) rates of 25 to 85 percent. In kidney transplant patients, EBWL rates are 31 to 61 percent.
This smaller percentage still adds up to major benefits say the St. Louis researchers considering the extent to which obesity has life-shortening consequences in kidney transplant patients.
