1. Outcomes of bariatric surgery after renal transplant: single center experience in Kuwait
Authors
Gheith O, Al-Otaibi T, Nampoory MRN, Halim M, Saied T, Hosni W, Zakareya zakareya ,Prasaad Nair and Jude Ajan 
Hamed Al-Essa Organ transplant center, Inb-Sina Hospital , El-Sabah Area ,Ministry of health , Kuwait

2. Introduction
Obesity has been associated with poor graft and patient survival after kidney transplantation, requiring functional increase of anti-rejection drugs.
Weight loss surgery may be a good alternative in this clinical scenario.

3. Introduction Indications: Morbid obesity (BMI >40), Type 2 DM,
Hypertension , 
Sleep apnea , and other co-morbid  conditions.

4. Introduction
Weight loss is achieved by reducing the size of the stomach with :
An implanted medical device (gastric banding)
Through removal of a portion of the stomach (sleeve gastrectomy or biliopancreatic diversion with duodenal switch)
or by resecting and re-routing the small intestines to a small stomach pouch (gastric bypass surgery).

5. Aim of the work
To assess the outcomes of bariatric procedures performed in patients after renal transplantation compared to conventional group of patients.

6. Patients and methods
In this retrospective study, collected database was conducted to analyze the outcomes of obese patients after kidney transplantation (BMI>38) who underwent bariatric procedures during the last 5 years (n=25cases) in comparison to controlled obese group without this type of surgery (n=41 cases).

7. Patients and methods
Roux-en-Y gastric bypass was the most common procedure. We aimed to evaluate this type of surgery among renal transplant patients in comparison to control group.

8. Demographic data of patients of both groups
Bariatric group
N=25
Control group
N=41
P value
Patient age (mean ±SD) years
Patient sex (Male/female)
Donor age (mean ±SD) years
Donor sex (Male/female)
Original kidney disease
Glomerulonephritis
Hypertension
Idiopathic
Dialysis type
Preemptive
Hemodialysis
Peritoneal dialysis
34 ±12.3
5/20
35.7±8.5
16/9 13 6 15 4
33.8±6.8
34/7
34.6±7.4
32/9 17 14 10 12 20 9
0.92
0.03
0.075
0.63
 0.41
0.44

9. Demographic data of patients of both groups
Bariatric group
N=25
Control group
N=41
P value
Donor type:
Live related
Live unrelated
Cadaveric
Early graft function:
Immediate graft function (%)
Slow graft function (%)
Delayed graft function (%)
Pre-transplant co-morbidities:
Anemia (%)
TB cases (%)
Diabetic (%)
Osteopenia (%)
Hypetension(%)
IHD(%) 14 7 4
66.7
16.7 40
6.3
11.1
46.2
100
0.0 20 12 9
61.4
25.3
13.3 60
9.8
20.1
30.8
89.9
5.6
0.138
0.721
0.185
0.674
0.220
0.125
0.210

10. BMI in both groups(basal and at last follow up)
The mean percentage of excess weight loss at 6 months in bariatric group was 15.4±5.1% (p<0.001).

11. Results
We found no significant difference in the two groups regarding number of cases with pre-transplant diabetes.
However, the total number of diabetics in the control group was significantly higher (73.3% vs. 40%, p=0.042).

12. Results
Moreover, we observed that rejection episodes, graft and patient outcomes were similar in both groups (p>0.05).
There were no postoperative complications except in two patients: one with strangulated hernia; and the second with postoperative deep venous thrombosis and pulmonary embolism.

13. Conclusion
Bariatric surgery (Roux en Y) may be used safely and effectively-with some precautions- to control obesity among renal transplant recipients.
Further improvement in metabolic parameters and long term patient and graft outcome can be observed only with longer and larger studies. 

14. Thank you