scholarly journals The role of bariatric surgery on kidney transplantation: A systematic review and meta-analysis

2021 ◽  
Vol 15 (10) ◽  
Author(s):  
Yung Lee ◽  
Luschman Raveendran ◽  
Olivia Lovrics ◽  
Chenchen Tian ◽  
Adree Khondker ◽  
...  
Keyword(s):  
Systematic Review ◽  
Bariatric Surgery ◽  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Severe Obesity ◽  
Meta Analysis ◽  
Weighted Mean ◽  
Safety And Efficacy ◽  
Baseline Bmi

Introduction: Obesity (body mass index [BMI] >35 kg/m2) remains a relative contraindication for kidney transplant, while patients after kidney transplantation (KTX) are predisposed to obesity. The present study aims to investigate the role of bariatric surgery in improving transplant candidacy in patients prior to KTX, as well its safety and efficacy in KTX patients postoperatively. Methods: A systematic search was conducted up to March 2020. Both comparative and non-comparative studies investigating the role of bariatric surgery before or after KTX were considered. Outcomes included change in BMI, rates of mortality and complications, and the rate of patients who underwent KTX following bariatric surgery. Pooled estimates were calculated using the random effects meta-analysis of proportions. Results: Twenty-one studies were eligible for final review; 11 studies investigated the role of bariatric surgery before KTX. The weighted mean BMI was 43.4 (5.7) kg/m2 at baseline and 33.9 (6.3) kg/m2 at 29.1 months followup. After bariatric surgery, 83% (95% confidence interval [CI] 57–99) were successfully listed for KTX and 83% (95% CI 65–97) patients subsequently received successful KTX. Ten studies investigated the role of bariatric surgery after kidney transplant. Weighted mean baseline BMI was 43.8 (2.2) kg/m2 and mean BMI at 19.5 months followup was 34.2 (6.7) kg/m2. Overall, all-cause 30-day mortality was 0.5% for both those who underwent bariatric surgery before or after receiving a KTX. The results of this study are limited by the inclusion of only non-randomized studies, limited followup, and high heterogeneity. Conclusions: Bariatric surgery may be safe and effective in reducing weight to improve KTX candidacy in patients with severe obesity and can also be used safely following KTX.

scholarly journals O-B03 Bariatric Surgery in Patients Awaiting a Kidney Transplant - Systematic Review and Personal Experience from a High Volume Bariatric Centre

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Karim Hamaoui ◽  
Neil Russell ◽  
Mohammed Al-Rashedy ◽  
Omer Al-Taan
Keyword(s):  
Systematic Review ◽  
Bariatric Surgery ◽  
Morbid Obesity ◽  
Weight Loss ◽  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Ckd Stage ◽  
Esrd Patients ◽  
High Bmi

Abstract Background Morbid obesity in end stage renal disease (ESRD) is a barrier to kidney transplantation due to potential suboptimal post-transplant outcomes. Bariatric surgery is the most effective treatment for morbid obesity and has been shown to improve transplant eligibility through weight loss. There is no national UK guidance with regards to the role of bariatric surgery in patients requiring a kidney transplant. We present a decade of experience from a large NHS tertiary referral bariatric centre of performing bariatric surgery for weight loss in a cohort of high BMI ESRD patients. Methods A retrospective review was conducted of all patients undergoing bariatric surgery between 2007-2017. All patients with chronic kidney disease (CKD) at the time of bariatric surgery were identified. Patient records for those with CKD stage 4 and Stage 5 (or ESRD) were reviewed and data extracted for analysis. A systematic review was also conducted of reported experiences of bariatric surgery in CKD patients as a bridge to kidney transplantation. Results Of 3119 patients operated on in the identified period 22 were identified as having CKD at the time of surgery. Sleeve gastrectomy was the most commonly performed procedure. There was no recorded post-operative complications or 30-day mortalities. Median LOS was 4 days (range:2-6), pre-operative BMI 45 (Range:37-69), 12m post-op excess weight loss 17.3±14.4%, final EWL 22.3±14.8% at 32 months follow-up (Range: 6-52). 57% were subsequently transplant wait listed, 28% proceeded to transplantation 18.5months after listing (Range:7-30months). Systematic review of 15 studies suggests bariatric surgery in these patients is safe and facilitates 1/4 of patients being listed and transplanted. Conclusions Experience from a large UK NHS bariatric centre shows weight-loss surgery in high BMI patients with CKD4/5 is safe, with minimal peri-operative morbidity and mortality. 1 in 2 patients proceeded to being listed for transplantation, and 1 in 3 progressed to transplantation. We should consider formalising the role of bariatric surgery in the pre-listing workup of high BMI ESRD patients in the UK to give all patients equal chances for transplantation.

scholarly journals Employment of Patients With Kidney Failure Treated With Dialysis or Kidney Transplantation - A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Lilli Kirkeskov ◽  
Rasmus Carlsen ◽  
Thomas Lund ◽  
Niels-Henrik Buus
Keyword(s):  
Systematic Review ◽  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Kidney Failure ◽  
Educational Level ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Employment Rate ◽  
Dialysis Patients ◽  
Post Transplant

Abstract Background: Patients with kidney failure treated with dialysis or kidney transplantation experience difficulties maintaining employ­­ment due to the condition itself as well as the treatment. We aimed to establish the rate of employment before and after initiation of dialysis and after kidney transplantation and to identify predictors of employment during dialysis and post-transplant.Methods: This systematic review and meta-analysis was carried out according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis, PRISMA, for studies that included employment rate in adults receiving dialysis or a kidney transplant. The literature search included cross sectional or cohort studies published in English in the period from January 1966 to August 2020 in the databases PubMed, Embase, and Cochrane Library. Data of employment rate, study population, age, gender, educational level, dialysis duration, kidney donor, ethnicity, dialysis modality, waiting time for transplantation, diabetes, and depression were extracted. Quality assessment was performed using the Newcastle-Ottawa Scale. Meta-analysis for predictors for employment and odds ratio; confidence intervals; and test for heterogeneity were calculated using Chi-squared statistics and I2. PROSPERO registration number: CRD42020188853.Results. 33 studies with 162,059 participants during dialysis and 31 studies with 137,742 participants receiving kidney transplantation. Dialysis patients were on average 52.6 years old (range 16-79), 60.3% males and kidney transplant patients 46.7 years old (range 18-78), 59.8% males. The employment rate (weighted mean) for dialysis patients was 26.3% (range 10.5-59.7%); pre-transplant 36.9% (range 25-86%), and post-transplant 38.2% (range 14.2-85%). Predictors for employment during dialysis and post-transplant were male, non-diabetic, peritoneal dialysis, and higher educational level, and post-transplant: pre-transplant employment, younger age, transplantation with a living donor kidney, and without depression.Conclusions: Patients with kidney failure had a low employment rate during dialysis, pre- and post-transplant. Kidney failure patients should be supported through a combination of clinical and social measures to ensure they remain in work.

Safety and Efficacy of Bariatric Surgery in Inflammatory Bowel Disease Patients: a Systematic Review and Meta-analysis

2020 ◽  
Vol 30 (10) ◽  
pp. 3872-3883 ◽  
Author(s):  
Rajat Garg ◽  
Babu P. Mohan ◽  
Suresh Ponnada ◽  
Amandeep Singh ◽  
Ali Aminian ◽  
...  
Keyword(s):  
Systematic Review ◽  
Bariatric Surgery ◽  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Meta Analysis ◽  
Safety And Efficacy ◽  
Inflammatory Bowel

scholarly journals Kidney transplant outcomes in HIV-positive patients: a systematic review and meta-analysis

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Xin Zheng ◽  
Lian Gong ◽  
Wenrui Xue ◽  
Song Zeng ◽  
Yue Xu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Kidney Transplantation ◽  
Antiretroviral Therapy ◽  
Acute Rejection ◽  
Kidney Transplant ◽  
Graft Survival ◽  
Patient Survival ◽  
Meta Analysis ◽  
Infectious Complications ◽  
Hiv Positive

Abstract Background Kidney transplantation is now a viable alternative to dialysis in HIV-positive patients who achieve good immunovirological control with the currently available antiretroviral therapy regimens. This systematic review and meta-analysis investigate the published evidence of outcome and risk of kidney transplantation in HIV-positive patients following the PRISMA guidelines. Methods Searches of PubMed, the Cochrane Library and EMBASE identified 27 cohort studies and 1670 case series evaluating the survival of HIV-positive kidney transplant patients published between July 2003 and May 2018. The regimens for induction, maintenance therapy and highly active antiretroviral therapy, acute rejection, patient and graft survival, CD4 count and infectious complications were recorded. We evaluated the patient survival and graft survival at 1 and 3 years respectively, acute rejection rate and also other infectious complications by using a random-effects analysis. Results At 1 year, patient survival was 0.97 (95% CI 0.95; 0.98), graft survival was 0.91 (95% CI 0.88; 0.94), acute rejection was 0.33 (95% CI 0.28; 0.38), and infectious complications was 0.41 (95% CI 0.34; 0.50), and at 3 years, patient survival was 0.94 (95% CI 0.90; 0.97) and graft survival was 0.81 (95% CI 0.74; 0.87). Conclusions With careful selection and evaluation, kidney transplantation can be performed with good outcomes in HIV-positive patients.

scholarly journals Employment of patients with kidney failure treated with dialysis or kidney transplantation—a systematic review and meta-analysis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Lilli Kirkeskov ◽  
Rasmus K. Carlsen ◽  
Thomas Lund ◽  
Niels Henrik Buus
Keyword(s):  
Systematic Review ◽  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Kidney Failure ◽  
Educational Level ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Employment Rate ◽  
Dialysis Patients ◽  
Cross Sectional

Abstract Background Patients with kidney failure treated with dialysis or kidney transplantation experience difficulties maintaining employment due to the condition itself and the treatment. We aimed to establish the rate of employment before and after initiation of dialysis and kidney transplantation and to identify predictors of employment during dialysis and posttransplant. Methods This systematic review and meta-analysis were carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines for studies that included employment rate in adults receiving dialysis or a kidney transplant. The literature search included cross-sectional or cohort studies published in English between January 1966 and August 2020 in the PubMed, Embase, and Cochrane Library databases. Data on employment rate, study population, age, gender, educational level, dialysis duration, kidney donor, ethnicity, dialysis modality, waiting time for transplantation, diabetes, and depression were extracted. Quality assessment was performed using the Newcastle–Ottawa Scale. Meta-analysis for predictors for employment, with odds ratios and confidence intervals, and tests for heterogeneity, using chi-square and I2 statistics, were calculated. PROSPERO registration number: CRD42020188853. Results Thirty-three studies included 162,059 participants receiving dialysis, and 31 studies included 137,742 participants who received kidney transplantation. Dialysis patients were on average 52.6 years old (range: 16–79; 60.3% male), and kidney transplant patients were 46.7 years old (range: 18–78; 59.8% male). The employment rate (weighted mean) for dialysis patients was 26.3% (range: 10.5–59.7%); the employment rate was 36.9% pretransplant (range: 25–86%) and 38.2% posttransplant (range: 14.2–85%). Predictors for employment during dialysis and posttransplant were male, gender, age, being without diabetes, peritoneal dialysis, and higher educational level, and predictors of posttransplant: pretransplant employment included transplantation with a living donor kidney, and being without depression. Conclusions Patients with kidney failure had a low employment rate during dialysis and pre- and posttransplant. Kidney failure patients should be supported through a combination of clinical and social measures to ensure that they remain working.

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