According to a recent retrospective study published in the May 2024 issue of Mayo Clinic Proceedings, sleeve gastrectomy significantly improves weight loss in patients with obesity and advanced chronic kidney disease (CKD), enhancing their eligibility for kidney transplantation.
Dr. Aleksandra Kukla, a transplant nephrologist at the Mayo Clinic in Rochester, Minnesota, highlighted that patients with a BMI over 40 often face difficulties accessing kidney transplants. The study indicates that sleeve gastrectomy improves health and transplant eligibility for dialysis patients. However, concerns about the procedure’s impact on functional status remain.
Kukla and colleagues reviewed records of 104 kidney transplant candidates with stages 4 and 5 CKD and obesity (BMI > 35 kg/m²) in the Mayo Clinic pretransplant metabolic program. Of these, 54 underwent sleeve gastrectomy, while 50 chose nonsurgical weight loss methods.
By 12 months, only the sleeve gastrectomy group achieved significant weight loss (mean 27 kg). Metabolic benefits included reduced insulin use among type 2 diabetes patients and fewer antihypertensive medications.
The study found sleeve gastrectomy expedited listing on the kidney transplant waitlist and tripled the odds of receiving a transplant. Three patients had postsurgical complications, including bleeding and gastrointestinal perforation. These issues did not generally affect transplant candidacy, though some delays occurred.
As reported by Medscape, the study noted a higher incidence of major adverse cardiovascular events (MACEs) in the sleeve gastrectomy group but could not definitively assess cardiovascular risks due to preexisting conditions.
Functional status concerns were noted, with declines in physical performance and increased frailty post-surgery. Dr. Kukla emphasized multidisciplinary evaluation, proper nutrition, and physical activity post-surgery to mitigate these risks.
Dr. Allon Friedman from Indiana University School of Medicine highlighted the potential benefits of sleeve gastrectomy but called for more data to establish safety and identify ideal candidates. A prospective study, PROFIT, is planned to address these key clinical questions.