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Ghanem OM, Pita A, Nazzal M, Johnson S, Diwan T, Obeid NR, Croome KP, Lim R, Quintini C, Whitson BA, Burt HA, Miller C, Kroh M. Obesity, organ failure, and transplantation: A review of the role of metabolic and bariatric surgery in transplant candidates and recipients. Am J Transplant 2024; 24:1534-1546. [PMID: 38951053 DOI: 10.1016/j.ajt.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/16/2024] [Accepted: 04/03/2024] [Indexed: 07/03/2024]
Abstract
Obesity is a risk factor for kidney, liver, heart, and pulmonary diseases, as well as failure. Solid organ transplantation remains the definitive treatment for the end-stage presentation of these diseases. Among many criteria for organ transplant, efficient management of obesity is required for patients to acquire transplant eligibility. End-stage organ failure and obesity are 2 complex pathologies that are often entwined. Metabolic and bariatric surgery before, during, or after organ transplant has been studied to determine the long-term effect of bariatric surgery on transplant outcomes. In this review, a multidisciplinary group of surgeons from the Society of American Gastrointestinal and Endoscopic Surgeons and the American Society for Transplant Surgery presents the current published literature on metabolic and bariatric surgery as a therapeutic option for patients with obesity awaiting solid organ transplantation. This manuscript details the most recent recommendations, pharmacologic considerations, and psychological considerations for this specific cohort of patients. Since level one evidence is not available on many of the topics covered by this review, expert opinion was implemented in several instances. Additional high-quality research in this area will allow for better recommendations and, therefore, treatment strategies for these complex patients.
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Affiliation(s)
- Omar M Ghanem
- Department of Surgery, Mayo Clinic Rochester, Minnesota, USA.
| | - Alejandro Pita
- Department of Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Mustafa Nazzal
- Department of Surgery, Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Shaneeta Johnson
- Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Tayyab Diwan
- Department of Surgery, Mayo Clinic Rochester, Minnesota, USA
| | - Nabeel R Obeid
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Robert Lim
- Atrium Health Carolinas Medical Center, Wake Forest University School of Medicine, Charlotte, North Carolina, USA
| | - Cristiano Quintini
- Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Bryan A Whitson
- Department of Surgery, Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Holly Ann Burt
- Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), Los Angeles, California, USA
| | - Charles Miller
- Department of Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Matthew Kroh
- Department of Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Ghanem OM, Pita A, Nazzal M, Johnson S, Diwan T, Obeid NR, Croome KP, Lim R, Quintini C, Whitson BA, Burt HA, Miller C, Kroh M. Obesity, organ failure, and transplantation: a review of the role of metabolic and bariatric surgery in transplant candidates and recipients. Surg Endosc 2024; 38:4138-4151. [PMID: 38951240 PMCID: PMC11289013 DOI: 10.1007/s00464-024-10930-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/03/2024] [Indexed: 07/03/2024]
Abstract
Obesity is a risk factor for kidney, liver, heart, and pulmonary diseases, as well as failure. Solid organ transplantation remains the definitive treatment for the end-stage presentation of these diseases. Among many criteria for organ transplant, efficient management of obesity is required for patients to acquire transplant eligibility. End-stage organ failure and obesity are 2 complex pathologies that are often entwined. Metabolic and bariatric surgery before, during, or after organ transplant has been studied to determine the long-term effect of bariatric surgery on transplant outcomes. In this review, a multidisciplinary group of surgeons from the Society of American Gastrointestinal and Endoscopic Surgeons and the American Society for Transplant Surgery presents the current published literature on metabolic and bariatric surgery as a therapeutic option for patients with obesity awaiting solid organ transplantation. This manuscript details the most recent recommendations, pharmacologic considerations, and psychological considerations for this specific cohort of patients. Since level one evidence is not available on many of the topics covered by this review, expert opinion was implemented in several instances. Additional high-quality research in this area will allow for better recommendations and, therefore, treatment strategies for these complex patients.
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Affiliation(s)
- Omar M Ghanem
- Department of Surgery, Mayo Clinic Rochester, Rochester, MN, USA.
| | - Alejandro Pita
- Department of Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Mustafa Nazzal
- Department of Surgery, Saint Louis University Hospital, St. Louis, MO, USA
| | - Shaneeta Johnson
- Department of Surgery, Morehouse School of Medicine, Atlanta, GA, USA
| | - Tayyab Diwan
- Department of Surgery, Mayo Clinic Rochester, Rochester, MN, USA
| | - Nabeel R Obeid
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | | | - Robert Lim
- Atrium Health Carolinas Medical Center, Wake Forest University School of Medicine, Charlotte, NC, USA
| | - Cristiano Quintini
- Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Bryan A Whitson
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Holly Ann Burt
- Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), Los Angeles, CA, USA
| | - Charles Miller
- Department of Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Matthew Kroh
- Department of Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
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Paraskeva MA, Snell GI. Advances in lung transplantation: 60 years on. Respirology 2024; 29:458-470. [PMID: 38648859 DOI: 10.1111/resp.14721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 04/03/2024] [Indexed: 04/25/2024]
Abstract
Lung transplantation is a well-established treatment for advanced lung disease, improving survival and quality of life. Over the last 60 years all aspects of lung transplantation have evolved significantly and exponential growth in transplant volume. This has been particularly evident over the last decade with a substantial increase in lung transplant numbers as a result of innovations in donor utilization procurement, including the use donation after circulatory death and ex-vivo lung perfusion organs. Donor lungs have proved to be surprisingly robust, and therefore the donor pool is actually larger than previously thought. Parallel to this, lung transplant outcomes have continued to improve with improved acute management as well as microbiological and immunological insights and innovations. The management of lung transplant recipients continues to be complex and heavily dependent on a tertiary care multidisciplinary paradigm. Whilst long term outcomes continue to be limited by chronic lung allograft dysfunction improvements in diagnostics, mechanistic understanding and evolutions in treatment paradigms have all contributed to a median survival that in some centres approaches 10 years. As ongoing studies build on developing novel approaches to diagnosis and treatment of transplant complications and improvements in donor utilization more individuals will have the opportunity to benefit from lung transplantation. As has always been the case, early referral for transplant consideration is important to achieve best results.
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Affiliation(s)
- Miranda A Paraskeva
- Lung Transplant Service, Department of Respiratory Medicine, Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - Gregory I Snell
- Lung Transplant Service, Department of Respiratory Medicine, Alfred Hospital and Monash University, Melbourne, Victoria, Australia
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Atchade E, De Tymowski C, Lepitre E, Zappella N, Snauwaert A, Jean-Baptiste S, Tran-Dinh A, Lortat-Jacob B, Messika J, Mal H, Mordant P, Castier Y, Tanaka S, Montravers P. Impact of recipient and donor pretransplantation body mass index on early postosperative complications after lung transplantation. BMC Pulm Med 2024; 24:161. [PMID: 38570744 PMCID: PMC10988822 DOI: 10.1186/s12890-024-02977-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/20/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Prior studies have assessed the impact of the pretransplantation recipient body mass index (BMI) on patient outcomes after lung transplantation (LT), but they have not specifically addressed early postoperative complications. Moreover, the impact of donor BMI on these complications has not been evaluated. The first aim of this study was to assess complications during hospitalization in the ICU after LT according to donor and recipient pretransplantation BMI. METHODS All the recipients who underwent LT at Bichat Claude Bernard Hospital, Paris, between January 2016 and August 2022 were included in this observational retrospective monocentric study. Postoperative complications were analyzed according to recipient and donor BMIs. Univariate and multivariate analyses were also performed. The 90-day and one-year survival rates were studied. P < 0.05 was considered to indicate statistical significance. The Paris-North Hospitals Institutional Review Board approved the study. RESULTS A total of 304 recipients were analyzed. Being underweight was observed in 41 (13%) recipients, a normal weight in 130 (43%) recipients, and being overweight/obese in 133 (44%) recipients. ECMO support during surgery was significantly more common in the overweight/obese group (p = 0.021), as were respiratory complications (primary graft dysfunction (PGD) (p = 0.006), grade 3 PDG (p = 0.018), neuroblocking agent administration (p = 0.008), prone positioning (p = 0.007)), and KDIGO 3 acute kidney injury (p = 0.036). However, pretransplantation overweight/obese status was not an independent risk factor for 90-day mortality. An overweight or obese donor was associated with a decreased PaO2/FiO2 ratio before organ donation (p < 0.001), without affecting morbidity or mortality after LT. CONCLUSION Pretransplantation overweight/obesity in recipients is strongly associated with respiratory and renal complications during hospitalization in the ICU after LT.
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Affiliation(s)
- E Atchade
- DMU PARABOL, APHP, CHU Bichat-Claude Bernard, Département d'anesthésie Reanimation, 46 Rue Henri Huchard, 75018, Paris, France.
| | - C De Tymowski
- DMU PARABOL, APHP, CHU Bichat-Claude Bernard, Département d'anesthésie Reanimation, 46 Rue Henri Huchard, 75018, Paris, France.
- UMR 1149, INSERM, Immunorecepteur Et Immunopathologie Rénale, CHU Bichat-Claude Bernard, 46 Rue Henri Huchard, 75018, Paris, France.
| | - E Lepitre
- DMU PARABOL, APHP, CHU Bichat-Claude Bernard, Département d'anesthésie Reanimation, 46 Rue Henri Huchard, 75018, Paris, France
| | - N Zappella
- DMU PARABOL, APHP, CHU Bichat-Claude Bernard, Département d'anesthésie Reanimation, 46 Rue Henri Huchard, 75018, Paris, France
| | - A Snauwaert
- DMU PARABOL, APHP, CHU Bichat-Claude Bernard, Département d'anesthésie Reanimation, 46 Rue Henri Huchard, 75018, Paris, France
| | - S Jean-Baptiste
- DMU PARABOL, APHP, CHU Bichat-Claude Bernard, Département d'anesthésie Reanimation, 46 Rue Henri Huchard, 75018, Paris, France
| | - A Tran-Dinh
- DMU PARABOL, APHP, CHU Bichat-Claude Bernard, Département d'anesthésie Reanimation, 46 Rue Henri Huchard, 75018, Paris, France
- INSERM U1148, LVTS, CHU Bichat-Claude Bernard, 46 Rue Henri Huchard, 75018, Paris, France
| | - B Lortat-Jacob
- DMU PARABOL, APHP, CHU Bichat-Claude Bernard, Département d'anesthésie Reanimation, 46 Rue Henri Huchard, 75018, Paris, France
| | - J Messika
- Service de Pneumologie B Et Transplantation Pulmonaire, APHP, CHU Bichat-Claude Bernard, 46 Rue Henri Huchard, 75018, Paris, France
- Université de Paris Cité, UFR Diderot, Paris, France
| | - H Mal
- Service de Pneumologie B Et Transplantation Pulmonaire, APHP, CHU Bichat-Claude Bernard, 46 Rue Henri Huchard, 75018, Paris, France
- Université de Paris Cité, UFR Diderot, Paris, France
| | - P Mordant
- Université de Paris Cité, UFR Diderot, Paris, France
- Service de Chirurgie Thoracique Et Vasculaire, APHP, CHU Bichat-Claude Bernard, 46 Rue Henri Huchard, 75018, Paris, France
| | - Y Castier
- Université de Paris Cité, UFR Diderot, Paris, France
- Service de Chirurgie Thoracique Et Vasculaire, APHP, CHU Bichat-Claude Bernard, 46 Rue Henri Huchard, 75018, Paris, France
| | - S Tanaka
- DMU PARABOL, APHP, CHU Bichat-Claude Bernard, Département d'anesthésie Reanimation, 46 Rue Henri Huchard, 75018, Paris, France
- UMR 1188, Université de La Réunion, INSERM, Diabète Athérothrombose Réunion Océan Indien (DéTROI), Saint-Denis de La Réunion, France
| | - P Montravers
- DMU PARABOL, APHP, CHU Bichat-Claude Bernard, Département d'anesthésie Reanimation, 46 Rue Henri Huchard, 75018, Paris, France
- Université de Paris Cité, UFR Diderot, Paris, France
- UMR 1152ANR-10LABX17Physiopathologie Et Epidémiologie Des Maladies Respiratoires, INSERM, Paris, France
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Diamond JM, Benvenuto L, Claridge T, Witek S, Christie JD, Singer JP, Anderson MR. Provider beliefs and practices regarding the management of obesity in lung transplant recipients. JHLT OPEN 2024; 3:100028. [PMID: 38223833 PMCID: PMC10783680 DOI: 10.1016/j.jhlto.2023.100028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Obesity at the time of lung transplant is associated with decreased survival. How providers manage obesity after lung transplantation is unknown. We performed an international survey of lung transplant providers to assess beliefs and practices regarding post-transplant obesity management. Eighty-one providers initiated the survey and 73 (90%) completed the full survey. Respondents were primarily North American-based pulmonary physicians. Nearly all providers believe treating obesity improves quality of life (99%) and survival (95%) after lung transplantation, but that only 41% of patients attempting weight loss are successful. While respondents nearly always recommend diet (96%), exercise (92%), and dietician consultation (89%), they less frequently recommend prescription weight loss medications (29%) or bariatric surgery (11%). Lung transplant providers are motivated to treat obesity in transplant recipients. However, there is a gap between general obesity treatment guidelines and lung transplant practice. Additional training, education, and trials in this population could address this gap.
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Affiliation(s)
- Joshua M Diamond
- Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Luke Benvenuto
- Department of Medicine, Columbia University Medical Center, NYC, NY
| | - Tamara Claridge
- Department of Pharmacy, University of Pennsylvania, Philadelphia, PA
| | - Stephanie Witek
- Department of Pharmacy, University of Pennsylvania, Philadelphia, PA
| | - Jason D Christie
- Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jonathan P Singer
- Department of Medicine, University of California at San Francisco, San Francisco, CA
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