Endocrine Abstracts

Objectives: The long-term outcome of bariatric surgery on renal function in the morbidly obese renal transplant recipient is still unknown. We describe three cases of morbidly obese renal transplant recipients who have subsequently undergone bariatric surgery.

Patient 1: A 44-year-old man (BMI 42.2 kg/m²) had received a renal transplant for chronic renal disease secondary to childhood reflux nephropathy. Laparoscopic Roux-en-Y gastric bypass resulted in 25.1 kg weight loss over 3 months. Long-standing proteinuria, glucosuria and urine blood trace resolved by 4 months and serum creatinine and cholesterol improved. His blood pressure medications were reduced post-bypass.

Patient 2: Patient 2 is a 51-year-old man (BMI 43.3 kg/m²) with a pancreas–kidney transplant for end stage renal failure (ESRF) secondary to diabetes. He required insulin and metformin following pancreatic graft failure. He lost 8 kg 4 months following sleeve gastrectomy. Insulin requirement was nil for 7 days post-sleeve gastrectomy but returned to pre-operative levels. Elevated blood urea, bicarbonate and potassium levels normalised. Creatinine remained normal, although urine protein creatinine ratio was raised and there was a need to readjust immunosuppressant medication.

Patient 3: Patient 3 is a 56-year-old man (BMI 39 kg/m²) who had received a kidney transplant for ESRF secondary to diabetes. Weight loss was 15 kg, 4 months following sleeve gastrectomy. Insulin requirement was reduced from 260 to 40 units post-sleeve gastrectomy, although HbA1c was consistently high. Irbesartan was commenced for hypertension. Serum creatinine and eGFR remained normal.

Conclusion: Bariatric surgery can be safe and successful in reducing weight and obesity related co-morbidities in the morbidly obese renal transplant recipient. Bariatric surgery in this cohort of patients can stabilise the renal transplant and improve some markers of renal function.