Background

Patients with ESRD and morbid obesity face challenges accessing kidney transplantation (KT). Bariatric surgery (BS) prior to KT can increase KT accessibility for these patients. However, the effect of BS on hemodynamics is limited in the literature. Here, we report the phenomenon of hypotension post-BS for our KT candidates that required medication to elevate their blood pressure post-BS allowing for dialysis.

Methods

We performed a two-year prospective analysis of KT candidates (BMI>35 and GFR<20) who received BS. We identified patients who developed hypotension (SBP <105 mm Hg) post-BS and did a multivariate logistic regression of variables associated with this.

Results

A total of 91 patients with ESRD were enrolled in our bariatric program (Table 1). Eighteen patients have undergone BS (75% Sleeve Gastrectomy (SG)/25% Roux-En-Y Gastric Bypass (RYGB)) to date. Nine patients developed hypotension at an average of 6 months post-bariatric surgery. Multivariate logistic regression analysis showed that pre-operative normotension (p<0.001) and RYGB (p=0.05) were significantly associated with the development of hypotension post-BS (Table 2). At 1-month post-operation, patients who underwent RYGB lost more weight than those with SG.

Conclusions

Patients with ESRD may have altered post-surgical hemodynamics. Postoperative hypotension is an unexpected finding and these patients may be unable to tolerate dialysis. Hypertension pre-operation and sleeve gastrectomy procedure were 'protective' against post-operation hypotension, and these considerations should be kept in mind when choosing bariatric options for patients with ESRD. Further studies with the MBSAQIP database may help understand the prevalence and causes of hypotension in this patient cohort.