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

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/m(2) 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/m(2) (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/m(2), 0.79 mg/dL, and 81.2 mL/min per 1.73 m(2), respectively. Conclusions. Combined robot-assisted kidney transplant and sleeve gastrectomy is feasible in morbidly obese patients and adds little additional operative time.