Morbid obesity has reached epidemic proportions in developed nations worldwide causing considerable mortality and increased healthcare expenditures. The use of gastric bypass to achieve weight loss in morbidly obese dialysis and post renal transplant patients has not been studied adequately.
Forty-one patients with different stages of chronic renal failure (CRF) (25 already on dialysis) underwent a gastric bypass (GBP) and nine of these had a subsequent renal transplant. An additional 10 patients underwent a GBP after becoming morbidly obese following transplantation.
Of the 41 patients with CRF, 5 stabilized or resolved their kidney disease and 9 were able to be successfully transplanted. These patients had a loss of 68% excess body weight by 12 months. There were no in hospital or 30 day mortalities, but 8 of the 51 patients died from 120-2,869 days postoperatively, seven from cardiac or vascular events and one from an automobile accident. This compares to an approximate 10% mortality per year for patients on dialysis. Comorbid conditions associated with the morbid obesity improved in all patients and permitted eligibility for transplantation. Of the 10 patients with GBP after transplant, the mean loss of excessive BMI was 70.5%. GBP for massive weight reduction in morbidly obese dialysis and transplant patients leads to a reduction in co-morbid conditions that increase the risk for cardiovascular deaths. There was no operative mortality in this series, and all but one death was related to previously existing disease of the cardiovascular system.