A prospective cohort study of laparoscopic sleeve gastrectomy for weight loss in obese patients on haemodialysis: proof of concept

ObjectivesSleeve gastrectomy (SG) is the most frequently performed bariatric surgery procedure worldwide, but reports on long-term quality of life (QOL) outcomes are scarce. We investigated 5-year trajectories in QOL and their associations with weight loss after SG.DesignA prospective cohort study.SettingThe study was conducted in a single Norwegian bariatric surgery centre.ParticipantsOut of 150 operated patients, 127 were included. Mean age was 41 years, 68% were women and the follow-up rate at 1 year was 85% and 64% at 1 and 5 years, respectively.Outcome measuresData were collected preoperatively, and 1 and 5 years after surgery assessing three different levels of QOL. The main exposure was weight loss after SG, assessed as per cent excess body mass index (kg/m2) loss (%EBMIL). The Obesity-Related Problem (OP) scale was used to measure obesity-specific health-related QOL (HRQOL). Physical (PCS) and mental (MCS) composite summary scores of the Short Form 36 Health Survey were used to capture generic HRQOL and Cantril Ladder was used to assess overall QOL.ResultsAll HRQOL/overall QOL measures significantly improved at 1 year, followed by modest decline from 1 to 5 years after surgery. Greater %EBMIL 5 years after surgery was significantly associated with improvements in OP and PCS scores, but not with MCS and Cantril Ladder scores. Although significant (p<0.001) and clinically relevant improvements in HRQOL/overall QOL outcomes were observed at 5 years, scores were still below the general population norms.ConclusionMost patients undergoing SG experience substantial weight loss accompanied by statistically significant and clinically relevant long-term improvements in HRQOL/overall QOL. However, an important minority of patients still report low HRQOL/overall QOL 5 years after SG. Further research should aim to identify other factors that contribute to impaired QOL after bariatric surgery, even in the presence of successful weight control.

Download Full-text

Impact of obesity in kidney transplantation: a prospective cohort study from French registries between 2008 and 2014

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab277 ◽

2021 ◽

Author(s):

Clarisse Grèze ◽

Bruno Pereira ◽

Yves Boirie ◽

Laurent Guy ◽

Clémentine Millet ◽

...

Keyword(s):

Weight Loss ◽

Cohort Study ◽

Kidney Transplantation ◽

Kidney Transplant ◽

Graft Survival ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Patient Survival ◽

Survival Rates ◽

Obese Patients

Abstract Background The access of obese patients to kidney transplantation is limited despite several studies showing that obese transplant recipients had a better survival rate than those undergoing dialysis. The aim of this study was to compare patient and graft survival rates and post-renal transplant complications in obese patients and non-obese patients and to assess the effect of pre-transplant weight loss in obese patients on transplant outcomes. Methods We carried out a prospective cohort study using two French registries REIN and CRISTAL on 7 270 kidney transplant patients between 2008 and 2014 in France. We compared obese patients with non-obese patients and obese patients who lost more than 10% of weight before the transplant (Obese WL and Obese nWL). Results The mean BMI in our obese patients was 32 kg/m2. Graft survival was lower in obese patients than in non-obese patients (HR = 1.40, IC 95% [1.09; 1.78], P = 0.007) whereas patient survival was similar (HR = 0.94, IC 95% [0.73; 1.23], P = 0.66). Graft survival was significantly lower in Obese WL than in Obese nWL (HR = 2.17, CI 95% [1.02; 4.63], P = 0.045) whereas patient survival was similar in the two groups (HR = 0.79, IC 95% [0.35; 1.77], P = 0.56). Conclusion Grade I obesity does not seem to be a risk factor for excess mortality after kidney transplantation and should not be an obstacle to having access to a graft. Weight loss before a kidney transplant in this patients should not be essential for registration on waiting list.

Download Full-text