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Bariatric Surgery in Kidney Transplant Candidates and Recipients: Experience at an Asian Center
Sarah Ying Tse Tan,Phong Ching Lee,Sonali Ganguly,Peng Chin Kek,Terence Kee,Quan Yao Ho,Sobhana Thangaraju 대한비만학회 2022 Journal of obesity & metabolic syndrome Vol.31 No.4
Background: Kidney transplant (KT) candidates and recipients with obesity experience more frequent complications such as infection, poorer allograft outcomes, diabetes, and mortality, limiting their eligibility for transplantation. Bariatric surgery (BS) is not commonly performed among KT patients given concerns about immunosuppression absorption, wound healing, infections, and graft outcomes. Its role has not been described before in an Asian KT patient setting. Methods: A retrospective review of patients who underwent BS at the largest KT center in Singapore from 2008 to 2020 was conducted. Metabolic outcomes, immunosuppression doses, graft outcomes, and mortality were studied. Results: Seven patients underwent BS and KT (4 underwent BS before KT, 3 underwent BS after KT; 4 underwent sleeve gastrectomy, 3 underwent gastric bypass). Mean total weight losses of 23.8% at 1 year and 18.6% at 5 years post-BS were achieved. Among the five patients with diabetes, glycemic control improved after BS. There were no deaths in the first 90 days or graft loss in the first year after KT and BS. Patients who underwent BS after KT had no significant changes in immunosuppression dose. Conclusion: BS can be safely performed in KT recipients and candidates and results in sustainable weight losses and improvements in metabolic comorbidities. Although no major complications were observed in our study, close monitoring of this complex group of patients is imperative.
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Hong Chang Tan,Matthew Zhen-Wei Tan,Kwang Wei Tham,Shanker Pasupathy,Alvin Kim Hock Eng,Sonali Ganguly,Oi Fah Lai,Alvin Choong Meng Ng 대한골다공증학회 2015 Osteoporosis and Sarcopenia Vol.1 No.2
Objectives: Bone loss after bariatric surgery is well recognized but the best method for quantifying bone mineral density (BMD) remains controversial. BMD measured with dual energy X-ray absorptiometry (DXA) is prone to measurement errors in this population while quantitative computed tomography (QCT) is less affected. We report the skeletal changes after bariatric surgery at 1-year in a multi-ethnic Asian cohort using both central DXA and QCT. Methods: Areal BMD (aBMD) and volumetric BMD (vBMD) of twenty-two participants (mean age 40.6; female 59%) undergoing sleeve gastrectomy (n ¼ 12) or gastric bypass (n ¼ 10) were measured with central DXA and QCT respectively before and 12-months after surgery. Results: Weight and BMI decreased significantly but discordant QCT and DXA results were noted. aBMD was significantly reduced at the total hip (TH) and femoral neck (FN) by 6.9 and 8.5% respectively but was not significantly different at the lumbar spine (LS). By contrast, there were no significant changes in vBMD at TH and FN. Instead, a significant 11.2% decrease in vBMD was noted at the LS. These findings were largely similar between the two surgical subgroups. Interestingly, cortical vBMD increased at both TH and FN while trabecular vBMD decreased at the TH. These changes were observed despite no significant post-operative changes in serum calcium, iPTH or 25-OH vitamin D levels. Conclusion: Technical or physiological factors may be involved in the discordance between QCT and DXA results during short-term follow-up and the most suitable method of bone density measurement for post-bariatric surgery patients remains uncertain. © 2015 The Korean Society of Osteoporosis. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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