Role of Bariatric Surgery in End-Stage Organ Failure

Abstract

As the prevalence of obesity is increasing with time, the presentation of morbid obesity with end-stage organ dysfunction is also increasing. Obesity related co-morbidities of hypertension and diabetes are inter-linked to chronic renal disease and cardiovascular disease, and the obesity related co-morbidity of NASH is interlinked to cirrhosis. Morbid obesity presents a high risk to transplantation, as these patients have been found to have increased risk of complications and allograft loss [1–5]. In addition morbid obesity increases the technical complexity of surgery. Weight loss is necessary to improve outcomes, help improve or resolve obesity-related comorbidities and make patients become eligible for transplantation based on strict BMI criteria existent in many centers [1–5]. Management of morbid obesity is important even in the post-transplant setting. However reduction of weight when contemplated in these high risk patients before transplantation is limited by time with lifestyle measures and increased risk of morbidity/mortality related to bariatric surgery. The aim of this chapter is to review the current literature on the role of surgically induced weight loss in patients with end stage organ dysfunction in a peri-transplant setting.