Combined Robot-assisted Kidney Transplantation and Sleeve Gastrectomy in a Morbidly Obese Recipient

In Brief Background Kidney transplantation confers a well-documented survival advantage for patients with end-stage renal disease (ESRD) over dialysis, regardless of body mass index (BMI). However, obese patients with ESRD have limited access to kidney transplantation. In most transplant centers, a patient with a BMI above 35 to 40 kg/m2 is either completely excluded from transplantation or is required to lose weight before being considered for transplantation. Materials and Methods Herein, we present the first case of a 35-year-old woman with a BMI of 42 kg/m2 (96.8 kg) and ESRD, who underwent combined robot-assisted kidney transplant and sleeve gastrectomy. Results The total operative time was 318 minutes with an estimated blood loss of 125 mL. At 24 months after transplantation, the patient’s weight, BMI, creatinine, and estimated glomerular filtration rate were 81.9 kg, 35.1 kg/m2, 0.79 mg/dL, and 81.2 mL/min per 1.73 m2, respectively. Conclusions Combined robot-assisted kidney transplant and sleeve gastrectomy is feasible in morbidly obese patients and adds little additional operative time. The authors report the first case of the combined robot-assisted kidney transplantation and sleeve gastrectomy in a morbidly obese patient. This technique can provide safe transplant surgical option and better survival for a morbidly obese CKD patients.