Lejuan Holmes's weight was keeping him from receiving a new kidney. With a Body Mass Index over 30, Holmes did not qualify to be on the waiting list for a new organ. To get him on the list, surgeons at Houston Methodist Hospital performed bariatric surgery to help him lose weight; a risky procedure for someone like Holmes who is a diabetic on dialysis.
"The surgery is the same for all patients, but dialysis increases the risk of bleeding, heart attack, infection, and other serious complications during surgery," said Dr. Vadim Sherman, medical director of the Bariatric and Metabolic Surgery Center at Houston Methodist Hospital. "We spoke with all of his other doctors and felt that the benefits outweighed the risks."
A published paper in a 2013 edition of the American Journal of Nephrology, based on multiple studies, shows that overweight people who receive kidney transplants are more prone to wound infections, transplant failure and heart disease after transplant. This is why the American Society of Transplantation recommends kidney patients make lifestyle changes, including diet and exercise, to achieve a BMI of 30 or lower before transplant.
Holmes's surgery was part of a Houston Methodist study looking at the safety and efficacy of bariatric surgery for dialysis patients. Sherman says most of these patients would otherwise have to stay on dialysis the rest of the lives with no hope of receiving a transplant. He believes this opens up a whole patient base and gives more people a chance to receive a life-saving organ.
"Most of these patients are not only seeing a reduction in weight, but also in their diabetes, high blood pressure and reflux diseases," Sherman said. "Within six months most of these patients are BMI eligible and can begin the process of getting on the transplant list."
Holmes had a gastric bypass, a surgery that involves reducing the size of the stomach and re-routing the small intestines to bypass a portion of the digestive tract. Although it varies from patient to patient, most bariatric patients lose anywhere from 2 to 4 pounds a week for the first 6 months, and then it tapers off to between 1 to 2 pounds a week.
Sherman says the study will expand to patients with other organ failures such as the heart and the liver, and will also look at specific changes in body fat composition and muscle.
"It takes a multi-disciplinary team working in concert to get these patients through the surgery and make them better candidates for transplant," Sherman said. "We are also operating on patients who have regained their weight after an initial transplant procedure and who are at risk of losing their organs. I believe this approach is going to give more of the patients a second chance at life."
The 41-year old Holmes, who lost both legs below his knees because of his diabetes, is currently going through the process of getting listed for transplant. He says he is looking forward to getting a new kidney and a new life.
"It's been a long hard road, but there is a light at the end of the tunnel," Holmes said. "I am looking forward to the day when I can get back to my job as a truck driver and put dialysis in my rearview mirror."
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