Obesity in the recipient is linked to inferior transplant outcome. Consequently, access to kidney transplantation (KT) is often restricted by body mass index (BMI) thresholds. Bariatric surgery (BS) has been established as a superior treatment for obesity compared to conservative measures, but it is unclear whether it is beneficial for patients on the waiting list.
MethodsA national survey consisting of 16 questions was sent to all heads of German KT centers. Current situation of KT candidates with obesity and the status of BS were queried.
ResultsCenter response rate was 100%. Obesity in KT candidates was considered an important issue (96.1%; n?=?49/51) and 68.6% (n?=?35/51) of departments responded to use absolute BMI thresholds for KT waiting list access with?≥?35 kg/m2 (45.1%; n?=?23/51) as the most common threshold. BS was considered an appropriate weight loss therapy (92.2%; n?=?47/51), in particular before KT (88.2%; n?=?45/51). Sleeve gastrectomy was the most favored procedure (77.1%; n?=?37/51). Twenty-one (41.2%) departments responded to evaluate KT candidates with obesity by default but only 11 (21.6%) had experience with?≥?n?=?5 transplants after BS. Concerns against BS were malabsorption of immunosuppressive therapy (39.2%; n?=?20/51), perioperative morbidity (17.6%; n?=?9/51), and malnutrition (13.7%; n?=?7/51).
ConclusionsObesity is potentially limiting access for KT. Despite commonly used BMI limits, only few German centers consider BS for obesity treatment in KT candidates by default. A national multicenter study is desired by nearly all heads of German transplant centers to prospectively assess the potentials, risks, and safety of BS in KT waitlisted patients.
Graphical abstract 相似文献Material and Methods: In 24 patients (15 M, 9 F; age range, 18-71 years) a total of 25 pulmonary nodules (in 1 patient 2 lesions simultaneously) were marked with a special wire under CT-guidance and then thoracoscopically resected. We evaluated lesion size, lesion distance to the pleura, the time of intervention, complications, and thoracoscopic success rate.
Results: Mean lesion size was 7 mm (range 4-15 mm) and mean lesional distance to the pleura was 13 mm (range 2-31 mm). The pulmonary nodule-marker system was positioned successfully in all 25 pulmonary nodules within 5-11 min (mean 7.5 min). Minimal pneumothoraces were observed in five patients with no requirements of chest drains. In addition, no bleeding complications or hematothorax were observed. All 25 pulmonary nodules could be resected thoracoscopically. However, in one patient (4%), the guide-wire dislocated during thoracoscopy, but the lesion could be successfully resected during thoracoscopy.
Conclusion: The CT-guided placement of the pulmonary nodule-marker system used here offers a safe and accurate guide for the localization of small pulmonary nodules during thoracoscopic resection. 相似文献