Laparoscopic sleeve gastrectomy improves renal transplant candidacy and posttransplant outcomes in morbidly obese patients.

Morbid obesity is a barrier to kidney transplantation due to inferior outcomes, including higher rates of new-onset diabetes after transplantation (NODAT), delayed graft function (DGF), and graft failure. Laparoscopic sleeve gastrectomy (LSG) increases transplant eligibility by reducing BMI in kidney transplant candidates, but the effect of surgical weight loss on posttransplantation outcomes is unknown. Reviewing single-center medical records, we identified all patients who underwent LSG before kidney transplantation from 2011-2016 (n = 20). Post-LSG kidney recipients were compared with similar-BMI recipients who did not undergo LSG, using 2:1 direct matching for patient factors. McNemar's test and signed-rank test were used to compare groups. Among post-LSG patients, mean BMI ± standard deviation (SD) was 41.5 ± 4.4 kg/m2 at initial encounter, which decreased to 32.3 ± 2.9 kg/m2 prior to transplantation (P < .01). No complications, readmissions, or mortality occurred following LSG. After transplantation, one patient (5%) experienced DGF, and no patients experienced NODAT. Allograft and patient survival at 1-year posttransplantation was 100%. Compared with non-LSG patients, post-LSG recipients had lower rates of DGF (5% vs 20%) and renal dysfunction-related readmissions (10% vs 27.5%) (P < .05 each). Perioperative complications, allograft survival, and patient survival were similar between groups. These data suggest that morbidly obese patients with end-stage renal disease who undergo LSG to improve transplant candidacy, achieve excellent posttransplantation outcomes.

Tube Feed Necrosis after Major Gastrointestinal Oncologic Surgery: Institutional Lessons and a Review of the Literature.

BACKGROUND: Small bowel necrosis after enteral feeding through a jejunostomy tube (tube feed necrosis, TFN) is a rare, serious complication of major abdominal surgery. However, strategies to reduce the incidence and morbidity of TFN are not well established. Here, in the largest series of TFN presented to date, we report our institutional experience and a comprehensive review of the literature. METHODS: Eight patients who experienced TFN from 2000 to 2014 after major abdominal surgery for oncologic indications at the University of Cincinnati were reviewed. Characteristics of post-operative courses and outcomes were reviewed prior to and after a change in tube-feeding protocol. The existing literature addressing TFN over the last three decades was also reviewed. RESULTS: Patients with TFN ranged from 50 to 74 years old and presented with upper gastrointestinal tract malignancies amenable to surgical resection. Six and two cases of TFN occurred following pancreatectomy and esophagectomy, respectively. Prior to TF protocol changes, which included initiation at a low rate, titrating up more slowly and starting at one-half strength TF, three of six cases of TFN (50%) resulted in mortality. With the new TF protocol, there were no deaths, goal TF rate was achieved 3 days later, symptoms of TFN were recognized 3 days earlier, and re-operation was conducted 1 day earlier. CONCLUSION: This case series describes a change in clinical practice that is associated with decreased morbidity and mortality of TFN. Wider implementation and further refinement of this tube-feeding protocol may reduce TFN incidence at other institutions and in patients with other conditions requiring enteral nutrition.

Clinical epidemiology of acute myocardial infarction in Sharjah, United Arab Emirates.

Little published information about the clinical epidemiology of acute myocardial infarction (AMI) in the United Arab Emirates (UAE) is available. To fill this knowledge gap, all patients with confirmed AMI who were treated at the intensive care unit of the Kuwait Hospital, Sharjah, during 1991 were prospectively studied. This hospital, primarily for expatriate patients, provides outpatient and hospital care to expatriates for a nominal fee and to UAE citizens free of charge. It is estimated that about 80% of all expatriate AMI patients in Sharjah receive initial treatment at this hospital. Of all 153 were recorded in 30.2 (39/129), 17.8 (27/152) and 14.6% (22/151) of the patients, respectively. Overall, 73.7% (112/152) of the patients were current cigarette smokers. Of all 153 patients, 48.4, 35.9, 7.2 and 8.5% had anterior, inferior, lateral and 'other' types of AMI, respectively. Of 152 patients with available data, 15 (9.9%) died in the hospital. In a multivariate logistic regression model including all significant univariate correlates of in-hospital death (age, nationality, history of hypertension and current smoking practice) as independent variables, only being a current cigarette smoker was significantly related to a lower risk of in-hospital death in the study patients (O.R. = 0.27; 95% C.I.: 0.08-0.96). Also, UAE Arab nationality and preexisting hypertension were notable, though nonsignificant, positive correlates of in-hospital death in this model. These finding should guide future in-depth studies of the clinical epidemiology of AMI in Sharjah and elsewhere in the UAE.