MP52-11 THE ROLE OF BARIATRIC SURGERY ON KIDNEY TRANSPLANTATION: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery II (MP52)1 Apr 2020MP52-11 THE ROLE OF BARIATRIC SURGERY ON KIDNEY TRANSPLANTATION: A SYSTEMATIC REVIEW AND META-ANALYSIS Yung Lee, Lucshman Raveendran*, Olivia Lovrics, Aristithes Doumouras, Martin Koyle, Monica Farcas, Yonah Krawkowsky, and Dennis Hong Yung LeeYung Lee More articles by this author , Lucshman Raveendran*Lucshman Raveendran* More articles by this author , Olivia LovricsOlivia Lovrics More articles by this author , Aristithes DoumourasAristithes Doumouras More articles by this author , Martin KoyleMartin Koyle More articles by this author , Monica FarcasMonica Farcas More articles by this author , Yonah KrawkowskyYonah Krawkowsky More articles by this author , and Dennis HongDennis Hong More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000914.011AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In patients with end-stage renal disease, kidney transplantation improves survival. However, due to safety and increased rates of graft failure, severe obesity (BMI > 35kg/m2) is a relative contraindication for kidney transplantation. Moreover, kidney transplant recipients are at high-risk for developing obesity. The aim of this systematic review and meta-analysis is to investigate the role of bariatric surgery before and after kidney transplantation. METHODS: Databases including MEDLINE, EMBASE, CENTRAL, PubMed, and Web of Science were searched up to March 2019, and included studies that performed bariatric surgery on patients with severe obesity (BMI >40 kg/m2 or BMI >35 kg/m2 with obesity-related comorbidities) before and after kidney transplantation. Included studies were categorized by whether kidney transplant was conducted before or after bariatric surgery. Outcomes for both groups included change in BMI and rates of surgical mortality and complications. For studies that performed bariatric surgery before transplant, additional outcomes included the rate of patients listed for renal transplantation after bariatric surgery and the number of patients who successfully received a transplant. Pooled estimates were calculated using the random effects meta-analysis of proportions. RESULTS: 17 studies were eligible for the final review. 8 studies investigated the role of bariatric surgery before kidney transplant (N=142, 54.2% female, mean age 49.0 [5.1]). The weighted mean baseline BMI was 43.3 (3.2) kg/m2 and mean BMI at 19.0 months follow-up was 34.3 (2.3) kg/m2. After bariatric surgery, the 30-day mortality rate was 0% and 84% of patients (95% CI 64%-98%) were successfully listed for transplant, 70.0% (95% CI 37%-95%) of whom underwent transplant. 4.2% of patients experienced minor 30-day complications and major 30-day complications occurred in 3.5% of patients. 9 studies investigated the role of bariatric surgery after kidney transplant (N=274, 51.6% female, mean age 47.2 [6.9]). Weighted mean baseline BMI was 44.1 (4.5) kg/m2 and mean BMI at 11.3 months follow-up was 35.7 (3.8) kg/m2. After bariatric surgery, the 30-day all-cause mortality rate was 0%. One minor (1.54%) and one major (1.54%) 30-day complication occurred in patients who received bariatric surgery after kidney transplant. CONCLUSIONS: Bariatric surgery appears safe and effective in reducing weight to improve kidney transplant candidacy and outcomes in patients with severe obesity, as well as in patients following kidney transplantation. Source of Funding: None to disclose. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e776-e776 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yung Lee More articles by this author Lucshman Raveendran* More articles by this author Olivia Lovrics More articles by this author Aristithes Doumouras More articles by this author Martin Koyle More articles by this author Monica Farcas More articles by this author Yonah Krawkowsky More articles by this author Dennis Hong More articles by this author Expand All Advertisement PDF downloadLoading ...