Weight Loss Surgery to Qualify for a Kidney Transplant

A fact in following Peritoneal Dialysis patients is most will pursue a kidney transplant. Another truth is that as many as 30-50% will initially be above the BMI limit set for them by the Transplant Team. Of this group given a specific amount of weight to lose, in our experience, less than 25% will accomplish this task, and usually that is when the amount required to lose was fairly minor to begin with. And we acknowledge when you combine PD, working, family demands, the fact you are tired to begin with, and a constant belly full of sugar, not to mention sometimes protein losses, it is hard to lose significant amounts of weight. All the while, you are remaining on dialysis, are not listed and your time is not going toward being on a list.
We also realize a shorter interval between initiation of dialysis and transplant is the most successful in terms of physical side effects of dialysis and long term transplant outcome.
With this in mind, we have begun to recommend surgical weight loss surgery in patients who are significantly obese but otherwise transplant suitable, on PD, and desirous of a transplant. At this point, 4 have had such surgery-3 gastric bypass, one gastric banding. The 3 most recent had no interuption of their peritoneal dialysis.(The 4th had the surgery done before dialysis began). All 4 have done well, with the weight loss less dramatic with the banding, although it has been steady. 2 of the patients met their weight loss goal for transplant in the first 2 months after surgery.
1 person has been listed. 2 are pending re-evaluation since surgery by the transplant team(all done recently) and the 4th is very close to weight goal. All 4 had no significant post operative complications.
Based on this, I have begun to recommend evaluation for several more of the patients who are obese and therefore not listed in the large PD group I follow. As for that, patients waiting in the same clinic waiting room for month after month tend to know each other and their respective stories. Once the patients see the patient who has had the weight loss surgery feeling and looking good,actively pursuing transplant now, the idea of being evaluated for this surgery(we send them to the same medical center-University of Miami-that does most of our kidney transplants),sells itself.

Stayed tuned for how it evolves.

RPA 2011

An amazing Renal Physicians Association Conference winds down, with complex lectures on ACO and ESRD Bundling dominating many of the lectures. More than ever, the national push will be towards home therapy for ESRD. We leave Washington D.C. with an even stronger committment to our home dialysis program, in particular to our very successful Peritoneal Dialysis Program and our outstanding team we have created for this therapy. While we were here, we got the news one of our PD patients, Jeff, got a kidney at University of Florida. We find PD helps keep our patients in as optimal health as possible while awaiting transplant.

Click here for Nephrolgist's tips to the PCP on Keeping Your Kidneys Healthy for Life

We think that the quest to stop kidney disease begins with your inquiry to your PCP on "How are my kidneys?" at your annual checkup. Too many times, your referral here is A) a big surprise to you and B) way too late to do much about it. A big myth is that there is little that can be done about kidney disease once it begins or "it runs in my family". Much can be done by early diagnosis, or even awareness that you are at high risk to develope it. We can teach you things your kidneys like and tell you medications we ourselves would never take becasue they can hurt kidneys(at least I wouldn't take them chronically). Do you know what they are?
There are medications that can protect you from development of kidney disease in certain chronic conditions, or slow the progression if it has already occurred. Click title to watch this Duke nephrologist educate primary doctors. You will know what to ask next time you see your doctor, even if you have perfectly healthy kidneys right n

ow. No one appreciates the little suckers until someone tells you they are not working at full capacity. Then you are all ears, but by then it maybe too late.

MORE ON WHO GETS THE BEST KIDNEY

Even among The Kidney Group, rationing of kidneys, potentially, in favor of younger patients is a hot button topic. One colleague called me this morning to say "Physiologic age is more important than chronological age", which I don't argue. "You should have said that", he insisted. But it is more than that. Another doctor in the group wants more studies that look at are we wasting kidneys on older people? How long do they last in a 70 year old vs a 30 year old? To which I clicked off the painful list of young patients in recent memory who lost a parent's kidney through neglect, including one who was a former employee's son. Can you think of a senior patient that did that, I asked? He could not.And of course, my mother asks "What is old?" (Correct answer-Not you, Mom).
It is a huge question with ethical and political ramifications that could be staggering. Is it the start of rationing of healthcare? Is dialysis next? Worrying what will be the shady side of the cut-off, or wondering what else will be rationed? Will I have the resources, then, to pay for health care denied me by age? Will you? Or your parents? I don't know. I only know, as I said last night, it's got me concerned.

SHOULD YOUNGER PATIENTS GET THE BEST KIDNEYS?

I am not in favor of sharp limits on who gets the best kidney-at least not strictly defined by age. What is old? In many countries, that age is 55. That's why, if they can afford it and have a donor, people from countries with these limits who need a transplant come here.(tough to do) Often, limits exist, in such places, on a variety of medical procedures.
From a purist standpoint, if they qualify to be listed, all patients should have a crack at the kidney that comes up when their number is called, so to speak. Why not? We have determined they will live a reasonable time by virtue of the fact they passed rigorous testing and were listed. And show me the nephrologist who has NOT had a few young patients squander this precious gift of a new kidney due to non-compliance borne of "I am just too young to get it". Not all young patients,of course, but you remember the ones who fall into this category. Do older folks ever do this? Well, I cannot think of one, although there is an exception, certainly, to every rule.
Now we have transplanted a fair number of patients in their 70's, with 78 being the oldest here at The Kidney Group. Ted. He lived to 89, and died of a cause unrelated to either the transplant or kidney disease. 11 years. Of course Ted was offered a 64 year old kidney. And was happy to get it. That happens frequently with an older patient because not every 37 year old waiting wants a 64 year old kidney. So the old guy gets it. And we understand that.
Do we need more organs? Yes. Is this the way to approach the problem? I am going to say "no". Age limits? It's a slippery slope, folks. And I, for one, don't like the thought of that.