Abstract: PUB357
Kidney Transplantation in Patients with Obesity and ESRD After Bariatric Surgery: A Case Series
Session Information
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Bekono-Nessah, Ingrid, SW Thames Renal and Transplantation unit, St helier Hospital, Epsom and St Helier University Hospitals NHS trust, London, United Kingdom
- Phanish, Mysore K., SW Thames Renal and Transplantation unit, St helier Hospital, Epsom and St Helier University Hospitals NHS trust, London, United Kingdom
Group or Team Name
- Transplant Team, St Helier Hospital, London, UK.
Introduction
Bariatric surgery is used to improve health and transplant (Tx) candidacy of obese patients with end-stage renal disease (ESRD). This report describes post-Tx challenges and outcomes in patients with prior sleeve gastrectomy.
We present 2 female and one male patient aged 50–69 with ESRD who underwent laparoscopic sleeve gastrectomy prior to kidney Tx. All received Basiliximab induction followed by Tacrolimus, MMF and prednisolone.
Case Description
Case 1: A 50Y-old white woman with ESRD and morbid obesity (wt 190kg, BMI 68) started haemodialysis (HD) in 2017. She underwent laparoscopic sleeve gastrectomy in Feb 2020. Wt loss was rapid and sustained (lost 76 kg) enabling her to achieve a target BMI to be listed for kidney Tx (Feb 2025). She received a living donor kidney Tx in March 2025. Post op recovery was uneventful. May 2025: S Creatinine 155µmol/L, eGFR, Wt 93Kg.
Case 2: A 69-year-old Black woman with ESRD secondary to type 2DM underwent sleeve gastrectomy in August 2022. Pre bariatric surgery wt-113kg (BMI 42). She lost 35kg, started PD in March 2024, listed on kidney Tx waitlist with a BMI of 30 and received a deceased donor (DD) kidney Tx in Nov 2024, uneventful. April 25: Creatinine 134, eGFR 35. Wt 5m post-Tx-83kg.
Case 3: A 62-year-old man with FSGS and morbid obesity (BMI 60) underwent sleeve gastrectomy in 2015. The wt came down to 95 kg (BMI 34) and he was activated on kidney Tx wait list in March 2020. After 5Y of HD he received a DD kidney Tx in October 2024. Post-op, he developed wound infection and delayed wound healing. He struggled to drink enough fluids, unable to eat much and lost significant amounts of wt (unintentional, 19kg wt loss by 4m post-Tx). CT scan revealed a fluid-filled esophagus, OGD showed no pathology. CMV PCRs negative. 6m post Tx: Creatinine 176, eGFR 35. Wt 73 Kg.
Discussion
Learning points: (1) Successful kidney Tx is achievable in patients with prior sleeve gastrectomy. Case 1 had surgery whilst on HD, other two had their surgery pre dialysis. Main GI symptoms post Tx were early satiety, nausea and GE reflux. All achieved adequate Tac levels. (2) Small capacity stomach makes ‘switch’ from fluid restriction to drinking large amounts of fluid post Tx challenging. (3) Patient 3 struggled to eat and lost weight post-transplant, MMF might have contributed. (4) None developed AKI due to hypovolemia.