Bariatric surgery as bridging therapy to kidney transplantation

The prevalence of obesity in adolescents is rising, including in those with kidney failure. Obesity increases the risk of complications during dialysis and may be associated with poorer outcomes after transplantation. Bariatric surgery has been found safe and effective in adults on dialysis. This Clinical Insights is about a 14-year-old female with kidney failure and obesity. She was initially managed on peritoneal dialysis but subsequently gained further weight. Multiple interventions for weight loss were unsuccessful, including the switch to haemodialysis. The patient underwent laparoscopic sleeve gastrectomy after extensive multidisciplinary assessment. She lost > 30 kg over 6 months (BMI decreased from 48 to 32 kg/m²) which made it possible for her to be activated on the deceased donor kidney transplant waiting list. Managing weight gain in patients on peritoneal dialysis is important, especially in obese adolescents. Bariatric surgery should be considered early where morbid obesity is a major impediment to listing for kidney transplantation.