Bariatric surgery before kidney transplantation

BACKGROUND: Patients with obesity and with the terminal stage of chronic kidney disease face difficulties when undergoing transplantation due to their body weight, however, the most efficient method of decreasing the body weight, which is the bariatric surgery, according to the current clinical recommendations, is contraindicated in cases of severe irreversible changes in the kidneys. CLINICAL CASE DESCRIPTION: The article provides the description of two clinical cases. In the first one, the patient aged 33 years (heavy smoker) with the body mass index of 44 kg/m2 and with severe manifestations of the diseases related to the obesity, having received programmed hemodialysis for 3 years, and after the preoperative preparation, he underwent the laparoscopic longitudinal gastric resection. In 13 months, with the decrease of the body mass index down to 25.3 kg/m2, he underwent a successful cadaveric kidney transplantation. Another patient aged 30 years with the body mass index of 40.6 kg/m2 and with 8 years programmed hemodialysis, also underwent the laparoscopic longitudinal gastric resection, and in 12 months, having the body mass index of 30 kg/m2 — a successful cadaveric kidney transplantation was carried out. In both patients, six months after the transplantation, the renal function has restored, with no decrease in the blood concentration of immunosuppressive drugs being observed. CONCLUSION: At the present moment in Russia, despite the existing discrepancies in the national clinical recommendations on kidney transplantation and in the clinical recommendations on the treatment of obesity in terms of bariatric surgery, the longitudinal gastric resection among the patients with the terminal stage of chronic kidney disease and morbid obesity can provide the possibility of transplanting the donor kidney with the minimal risk of transplant failure.