Gastric bypass in morbidly obese patients with chronic renal failure and kidney transplant

BACKGROUND: Morbid obesity occurs frequently in patients with renal failure and is associated with an increased mortality, particularly from cardiovascular disease, as well as a marked increase in comorbid conditions affecting quality of life. Morbid obesity is also associated with an increased risk of complications and death in transplant patients and is often a cause for denial for access to transplantation. METHODS: Thirty morbidly obese patients with chronic renal failure or transplantation underwent gastric bypass (GBP). Nineteen patients had chronic renal failure at the time of GBP, eight had transplantation followed by GBP, and three had GBP and then transplantation. RESULTS: The reduction in excess body mass index (above 25) after GBP at 1, 2, and 3 years was similar to patients without transplantation or chronic renal failure, approximately 70% at 1 year. Comorbid conditions were diminished in each subset of patients, decreasing their risk for potential cardiovascular complications. One patient died 7.9 years after a GBP and 6.1 years after transplantation from cardiovascular disease related to longstanding diabetes that was present before her renal failure. CONCLUSIONS: GBP is a safe and effective means for achieving significant long-term weight loss and relief of comorbid conditions in patients with renal failure on dialysis, in preparation for transplantation, or after transplantation.