Patients who need to lose weight to have a renal transplant have several bariatric options.
Although higher BMI seems to confer a survival benefit on dialysis patients, obesity can be an obstacle to renal transplantation.
Dietary modifications and exercise remain the first approach to achieving a desired body weight, but if these efforts fail, is bariatric surgery a viable option for people with CKD?
A review of recent studies provides examples of surgical weight-control strategies to assist renal transplant candidates, as well as new evidence comparing efficacy of methods used (i.e., gastric bypass vs. laparoscopic gastric banding).
Positive results of laparoscopically adjustable gastric banding (LAGB) for renal transplant candidates are presented in a current case report (Am J Kidney Dis. 2008;52:e15-e17). The authors describe the process of LAGB as “placement of a silicone band around the proximal part of the stomach laparoscopically, which reduces the volume of food that can be ingested.”
These case studies of the successful use of LAGB in three dialysis patients (BMI range 35.1-44.1 kg/m2) demonstrate an average weight reduction of 13.8% (range 12.8%-15%) in the 12-15 months prior to renal transplant surgery. Although one patient maintained the lower weight post-transplant, the other two patients did experience some weight regain (BMI from 30.4 to 38 and from 37 to 38.5).
The authors attribute this weight increase to “adjustments in the laparoscopically adjustable gastric band to accommodate the patient’s varying medication, fluid, and nutritional requirements.” An earlier case series (Obes Surg. 2005;15:567-570) reports similar success with LAGB for pre-transplant weight loss, though post-transplant weight experience was not indicated.
Although LAGB can assist morbidly obese (BMI greater than 35) CKD patients in achieving weight loss for transplant, this technique is not without risks. Two potential complications, band erosion and band migration, are presented in a case report (Transplant Proc. 2006;38:3109–3111).
In both instances, the complications occurred post-transplant and resulted in removal of the gastric bands. The authors note that in the patient who experienced intragastric band erosion, “it is possible that the implementation of immunosuppression either initiated or accelerated the erosion.”