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Simultaneous robotic kidney transplant and bariatric surgery is safe

Tue, 11/10/2020 - 14:14
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Kidney transplants are frequently denied to patients with obesity, partly due to an increased risk of surgical complications, particularly infections. Now surgeons at University of Illinois Chicago Heath who have pioneered the use of robotic-assisted surgery has shown that robotic-assisted kidney transplant and bariatric surgery can be performed safely to successfully reduce surgical complications. The procedure has opened up a life-saving door to patients who would otherwise be stuck on dialysis to treat their kidney disease, which carries its own serious risks.

The team, led by Dr Enrico Benedetti, professor and Warren H Cole Chair of Surgery, performed the world’s first simultaneous robotic kidney transplant and sleeve gastrectomy in July 2012. The results from the small, prospective, randomised controlled trial, ‘Simultaneous robotic kidney transplantation and bariatric surgery for morbidly obese patients with end‐stage renal failure’, were published in the American Journal of Transplantation.

"Obesity is a major risk factor for kidney disease," said Dr Pierpaolo Di Cocco, assistant professor of surgery at UIC and co-author of the paper. "Performing robotic-assisted weight loss surgery together with kidney transplant is the logical next step because with one surgery, we give the transplant a better shot at success because the weight loss the patient will experience helps improve cardiac function and reduce stress on the new organ."

Di Cocco and colleagues enrolled 20 patients into the study between 2012 and 2019. On average, patients had body mass indices (BMI) of 44.

Eleven patients received a robotic-assisted kidney transplant and sleeve gastrectomy and nine patients received robotic-assisted kidney transplantation alone. All patients received weight-loss education and participated in a medically supervised weight loss programme, which consisted of exercise and diet recommendations as well as visits with a multidisciplinary team of bariatric surgeons, nurse practitioners, medical consultants, dietitians, psychologists and exercise physiologists.

Patients who underwent both procedures were under anaesthesia and the length of surgery was longer in the robotic sleeve gastrectomy and robotic‐assisted kidney transplant group (405 minutes vs. 269 minutes, p0=0.00304) without increase in estimated blood loss (120 ml vs. 117 ml, p=0.908) or incidence of surgical complications. Two patients in the kidney transplant group experienced organ rejection at one year and three years post-surgery. No patients in the kidney-transplant-plus-sleeve-gastrectomy group experienced organ rejection.

At 12‐month follow‐up, change in body mass index was –8.76 ± 1.82 in the robotic sleeve gastrectomy and robotic‐assisted kidney transplant group compared to 1.70 ± 2.30 in the robotic kidney transplant group (p=.0041). Patients in the dual-procedure group experienced an approximately 50% drop in excess weight. Estimated glomerular filtration rate, serum creatinine, readmission rates, and graft failure rates up to 12 months were not different between the two groups.

"With this simultaneous surgical approach, we can address end-stage kidney disease obesity, a major player in kidney disease, at the same time with a single operation and a single course of anaesthesia," said Dr. Tzvetanov, associate professor of surgery, chief of transplantation and a co-author on the paper.

"While it is encouraging that patients can safely undergo both robotic-assisted kidney transplant and weight loss surgery safely, it will take more follow-up time for us to understand all the potential benefits of this procedure," added Tsvetanov.