Background

Morbid obesity serves as a barrier to kidney transplantation (KT) due to poor post-transplant outcomes. Laparoscopic sleeve gastrectomy (LSG) has previously been shown to improve transplant eligibility via weight loss. We aimed to examine the role LSG plays in improving outcomes post-KT, including possible effects on new onset diabetes after transplant (NODAT).

Methods

A single-center analysis was performed identifying all patients who underwent KT after LSG from 2011-2017 (n=41). Exclusion criteria included type I DM and previous pancreas transplantation. NODAT was defined as a new insulin requirement after KT. Delayed graft function (DGF) was defined as need for dialysis within the first week after KT. Mean post-transplant follow-up period was 22 months.

Results

41 patients underwent KT after LSG after median time of 16 months. Median age of post-LSG patients was 56.0 years at time of KT. Most patients were Caucasian and male. Average BMI decreased by nine from the time of LSG to KT, and no patients regained weight after one year. After LSG, the number of patients with HTN (85.4% vs 48.5%) and the number of antihypertensive medications used decreased significantly (1.6 vs 0.6) at time of KT (p<0.001 each). At one-year follow-up, the improvement in HTN persisted (51.2% vs 48.5%, p=NS). The average insulin regimen also decreased from 33.0±51.6 to 11.7±21.5 daily units at time of KT (p<0.001). This improvement also persisted at one-year follow-up (11.9 vs 11.7 units, p=NS). Zero patients suffered NODAT over the follow-up period, in comparison to our institutional rate of NODAT at 15.8%. One patient developed DGF (2.4%) after KT, compared to our institutional rate of 13.3%. After one-year post-KT period, there was one graft loss (2.4%) and no patient mortality.

Conclusions

This is the largest reported series of kidney transplant after planned LSG in morbidly obese patients.Our results confirm excellent post-transplant outcomes among patients who otherwise would have been denied KT eligibility.