TY - JOUR
T1 - Feasibility and outcomes of laparoscopic sleeve gastrectomy after solid organ transplantation
AU - Khoraki, Jad
AU - Katz, Micah G.
AU - Funk, Luke M.
AU - Greenberg, Jacob A.
AU - Fernandez, Luis A.
AU - Campos, Guilherme M.
N1 - Publisher Copyright:
© 2016 American Society for Metabolic and Bariatric Surgery. All rights reserved.
PY - 2016/1
Y1 - 2016/1
N2 - Background: Obesity is common after solid organ transplantation and is associated with worse transplantation-related outcomes. Laparoscopic sleeve gastrectomy (LSG) may be the preferred bariatric operation in transplantation patients over other techniques, such as gastric bypass, given the concerns about medication absorption. However, little is known about LSG outcomes in posttransplantation patients. Objectives: We report the outcomes in 10 consecutive patients who underwent solid organ transplantation followed by LSG. Setting: An academic medical center. Methods: Primary outcomes studied were weight loss, perioperative complications, resolution or improvement of obesity-related co-morbidities, and markers of graft function following LSG. Results: The types of transplantation before LSG were as follows: liver = 5, kidney = 4, and heart = 1. Mean body mass index (BMI) at LSG was 44.7 ±1.7 kg/m . All patients had hypertension, and 6 had type 2 diabetes. Perioperative complications occurred in 2 patients, and there were no deaths. Excess weight loss at 12 and 24 months after LSG was 45.7% and 42.5%, respectively. At 1 year after LSG, there was a significant reduction in the number of antihypertensive medications (2.4 to 1.5; P = .02). Three patients achieved complete remission of type 2 diabetes, and the other 3 significantly reduced their dosages of insulin. Graft function remained preserved in liver transplantation patients; left ventricular ejection fraction (LVEF) increased by 10% in the heart transplantation subject, and the estimated glomerular filtration rate (eGFR) increased significantly in kidney transplantation patients (53 ± 3 to 82 ± 3 mL/min; P = .03). Conclusions: We concluded that LSG, in selected patients with severe obesity after solid organ transplantation, results in significant weight loss, improvement or resolution of obesity-related conditions, and preservation or improvement of graft function. Larger studies are needed to determine tolerability standards.
AB - Background: Obesity is common after solid organ transplantation and is associated with worse transplantation-related outcomes. Laparoscopic sleeve gastrectomy (LSG) may be the preferred bariatric operation in transplantation patients over other techniques, such as gastric bypass, given the concerns about medication absorption. However, little is known about LSG outcomes in posttransplantation patients. Objectives: We report the outcomes in 10 consecutive patients who underwent solid organ transplantation followed by LSG. Setting: An academic medical center. Methods: Primary outcomes studied were weight loss, perioperative complications, resolution or improvement of obesity-related co-morbidities, and markers of graft function following LSG. Results: The types of transplantation before LSG were as follows: liver = 5, kidney = 4, and heart = 1. Mean body mass index (BMI) at LSG was 44.7 ±1.7 kg/m . All patients had hypertension, and 6 had type 2 diabetes. Perioperative complications occurred in 2 patients, and there were no deaths. Excess weight loss at 12 and 24 months after LSG was 45.7% and 42.5%, respectively. At 1 year after LSG, there was a significant reduction in the number of antihypertensive medications (2.4 to 1.5; P = .02). Three patients achieved complete remission of type 2 diabetes, and the other 3 significantly reduced their dosages of insulin. Graft function remained preserved in liver transplantation patients; left ventricular ejection fraction (LVEF) increased by 10% in the heart transplantation subject, and the estimated glomerular filtration rate (eGFR) increased significantly in kidney transplantation patients (53 ± 3 to 82 ± 3 mL/min; P = .03). Conclusions: We concluded that LSG, in selected patients with severe obesity after solid organ transplantation, results in significant weight loss, improvement or resolution of obesity-related conditions, and preservation or improvement of graft function. Larger studies are needed to determine tolerability standards.
KW - Bariatric surgery
KW - Graft function
KW - Heart transplantation
KW - Immunosuppression
KW - Kidney transplantation
KW - Laparoscopic sleeve gastrectomy
KW - Liver transplantation
KW - Obesity
KW - Transplantation
KW - Type 2 diabetes
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U2 - 10.1016/j.soard.2015.04.002
DO - 10.1016/j.soard.2015.04.002
M3 - Article
C2 - 26048513
AN - SCOPUS:84959512948
SN - 1550-7289
VL - 12
SP - 75
EP - 83
JO - Surgery for Obesity and Related Diseases
JF - Surgery for Obesity and Related Diseases
IS - 1
ER -