2 YEAR METABOLIC HEALTH OUTCOMES IN PATIENTS UNDERGOING BARIATRIC SURGERY AFTER RENAL AND HEPATIC TRANSPLANT
Laxmi P. Dongur*, Yara Samman, Sarah Samreen
The University of Texas Medical Branch at Galveston, Galveston, TX
Background: Obesity is a metabolic disease affecting 50% post-transplant patients leading to a 2-fold increase in long-term graft loss. Patients are at an increased risk for weight gain partly due to the side effects of immunosuppressive medications. Bariatric surgery (BS) has been studied in patients prior to transplantation; an intervention that has improved transplant candidacy and post-transplant complications. However, little is known about the safety and efficacy of BS after transplant surgery. We aimed to evaluate the metabolic outcomes upto 2 years after BS in renal and hepatic allograft recipients.
Methods: A retrospective, multi-institutional study was conducted using the TriNetX database. A total of 61 RAR and 68 HAR, who underwent BS, were compared to a cohort of 24,361 RAR and 56,286 HAR, who did not undergo BS. The cohorts were propensity matched to BMI over 35 kg/m2.
Results: Maintenance immunosuppression was similar between the groups and consisted of tacrolimus, mycophenolate, and prednisone. Overall mortality was significantly reduced in renal allograft recipients (RAR) after BS at 6 months, 1-year, and 2-year mark (p<0.05 in all). Overall mortality was significantly reduced in hepatic allograft recipients (HAR) after BS at 6 months and 1 year (p<0.05 in both). However, no mortality difference was noted at the 2-year mark in HAR. Hemoglobin A1c (HbA1c) levels were not significantly different in RAR at 6-month mark (p>0.05). HbA1c was not significantly different in HAR at 6-month mark, 1-year mark, and 2-year mark (p>0.05). Hypertension (HTN) was not significantly different in RAR at 6-month mark (p>0.05). HTN was significantly increased in HAR after BS at 6-month mark, 1-year mark, and 2-year mark (p<0.05). The risk of sleep apnea was significantly reduced in RAR after BS at 6-month mark (p=0.01), but significantly increased at 1-year and 2-year mark. Overall acute coronary symptoms (ACS) were significantly reduced in RAR after BS at 6-month mark (p<0.05). No difference was noted in ACS at the 1-year and 2-year mark in RAR after BS. Unstable angina and ST-Elevation Myocardial Infarction (STEMI) were not significantly different in RAR and HAR after BS at 6-month mark, 1-year mark, and 2-year mark. There was significant reduction in incidence of low glomerular filtration rate (GFR) in RAR after BS at 6-month mark, 1-year mark and 2-year mark (p<0.05). There was significant reduction in AKI in RAR after BS at 6-month mark and 1-year mark (p<0.05). No significance in risk of graft loss was noted in HAR at 6-month mark, 1-year mark, and 2-year mark (p>0.05).
Conclusion: Bariatric surgery for treatment of morbid obesity in renal and hepatic allograft recipients is a safe procedure that has the potential to reduce the risk of sleep apnea and AKI in renal allograft recipients and hypertension and graft loss in hepatic allograft recipients.
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