Related Experiment Video
Updated: May 26, 2026
09:15
Orthotopic Rat Kidney Transplantation: A Novel and Simplified Surgical Approach
Published on: May 7, 2019
15.8K
Collaborative Approach Toward Transplant Candidacy for Obese Patients with End-Stage Renal Disease
Shauna Levy1, Abdallah Attia1, Mahmoud Omar2
1From the Divisions of Bariatric and Minimally Invasive Surgery (Levy, Attia, Galvani).
Journal of the American College of Surgeons
|March 12, 2024
Summary
A collaborative bariatric and transplant surgery program offers a viable pathway to kidney transplantation for patients with end-stage renal disease (ESRD) and obesity. This integrated approach improves comorbidities and may enhance transplant outcomes.
Area of Science:
- Nephrology
- Bariatric Surgery
- Transplant Surgery
Background:
- Elevated BMI is a significant barrier to kidney transplantation for end-stage renal disease (ESRD) patients.
- This barrier disproportionately affects minority and low-income populations, increasing dialysis costs.
- Metabolic bariatric surgery (MBS) is underutilized in this patient group.
Purpose of the Study:
- To evaluate the outcomes of a collaborative program offering metabolic bariatric surgery (MBS) prior to kidney transplantation for ESRD patients.
- To assess the impact of MBS on BMI, comorbidities, and transplant success in ESRD patients.
Main Methods:
- A retrospective study of 183 ESRD patients referred for MBS between January 2019 and June 2023.
- 36 patients underwent MBS (20 Roux-en-Y gastric bypass, 16 sleeve gastrectomy); 10 received transplants, 15 are waitlisted.
- Shared resources (dietitians, social workers, database) facilitated team collaboration.
Main Results:
- Mean BMI decreased from 46.4 kg/m² at referral to 33.9 kg/m² at transplant.
- Hypertension medication use decreased, and hemoglobin A1C levels improved significantly post-MBS.
- All 10 post-MBS transplants are functioning well, with a median creatinine of 1.5 mg/dL.
Conclusions:
- A collaborative MBS and transplant surgery program provides a viable transplant pathway for obese ESRD patients.
- This approach can potentially reduce healthcare disparities and improve post-transplant outcomes.
- ESRD patients undergoing MBS require awareness of unique potential complications.
Related Concept Videos
01:21Drug Dosing: Obese Patients
In the United States, obesity is a prominent concern. It is linked to heightened mortality rates due to increased occurrences of conditions such as hypertension, atherosclerosis, coronary artery disease, and diabetes compared to nonobese individuals. A patient is classified as obese if their actual body weight surpasses the ideal or desirable body weight by 20%, based on Metropolitan Life Insurance Company data. Ideal body weights consider average weights and heights for males and females...
01:20Pharmacokinetics in Obese Patients: Drug Metabolism and Excretion
Drug metabolism, a critical process in the liver, involves two primary phases: Phase I reactions and Phase II conjugation. Obesity introduces significant alterations in this metabolic process, primarily due to fatty infiltration of the liver, leading to conditions such as nonalcoholic fatty liver disease (NAFLD). This condition can modify the activities of both Phase I and II enzymes, impacting how drugs are metabolized in obese patients.Phase I metabolism sees variable effects across...
01:28Kidney Transplant I: Introduction
A kidney transplant is a surgical approach that involves replacing a non-functioning kidney with a healthy one from a donor. This procedure is often a treatment option for end-stage renal disease (ESRD) patients. The method requires careful recipient selection, including evaluating various medical and psychosocial factors. These criteria vary between transplant centers but generally include assessments of the patient's overall health, adherence to medical recommendations, and lifestyle...
01:26Kidney Transplant II: Surgical Procedure
Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living donor...
01:16Kidney Transplant III: Nursing Management
Postoperative Nursing Management for Kidney Transplant PatientsPostoperative nursing management care includes monitoring the surgical site, encouraging early movement, and promoting lung health through breathing exercises. Nurses also administer prescribed medications like H2-blockers, such as famotidine, or proton pump inhibitors, like omeprazole, to help prevent gastrointestinal ulcers and bleeding. Fungal infections in the mouth and bladder can result from immunosuppressive and antibiotic...
01:28Chronic Kidney Disease III: Interprofessional Care
Chronic kidney disease (CKD) requires collaborative and comprehensive management. CKD progresses through stages and can lead to end-stage kidney disease (ESKD) if untreated. Interprofessional collaboration and patient education are crucial, enabling patients to manage their health and improve their quality of life.Diagnostic approach for chronic kidney diseaseThe diagnosis of CKD primarily focuses on the glomerular filtration rate (GFR), which assesses kidney function by measuring how well...