Use of the INAMED LAPBAND System to Reduce BMI's in Obese Renal Failure Patients

The concern of transplant surgeons is that obese patients with high BMI's are more likely to
experience post-transplantation complications than age-matched recipients [1]. Nevertheless,
the Summa transplant list contains numerous patients with renal failure that have BMI's above
35. These patients are not considered to be "active" transplant candidates because of their
obesity and are not eligible to receive a kidney transplant. Dr. Lal counsels these patients
that they must lose weight in order to be considered active candidates for transplantation.

Weight loss for obese patients in renal failure is difficult. These patients must undergo
hemodialysis three times weekly. Most of these patients do not, or physically cannot, engage
in exercise activities. Many of these patients are burdened psychologically, and further
behavioral responsibilities related to weight loss may overstress them. Repetitive diets or
behavioral therapy in morbidly obese patients prior to transplantation have had disappointing
results [2]. Likewise, pharmacological management of obesity in these patients is largely
unsuccessful. Noradrenergic appetite suppressants must be restricted because of stimulatory
side-effects. Serotonergic agents have cardiovascular and pulmonary complications.
Thermogenic agents are minimally effective [2].

The INAMED LAPBAND SYSTEM is an FDA-approved, surgically-placed device marketed to facilitate
weight reduction in obese individuals. The LAPBAND is positioned laparoscopically around the
stomach and requires an overnight hospitalization and an upper GI swallow the next morning.
The device can be gradually adjusted to increase stomach constriction by the physician in an
office setting so that the patient loses approximately 1-2 pounds per week over two years.
These adjustments are performed on average 4-5 times during the first year and twice during
the second year.

The purpose of this pilot study is to assess the utility of the LAPBAND in facilitating
weight loss in obese renal failure patients awaiting transplantation and to document issues
related to its use in these patients. The hope is that the LAPBAND will facilitate enough
weight loss to reduce the patient's BMI to 35 or below after placement of the LAPBAND. If the
patient reaches the intended goal of BMI of 35, they will be placed on the active renal
transplant list and will be eligible for transplantation.

A secondary goal of this research is to follow those patients who successfully reach BMI's of
35 or less who are subsequently transplanted to determine any untoward effects of the LAPBAND
upon transplantation success

Inclusion Criteria:

- 18 or older

- Hemodialysis patient with BMI between 36 and 42

Exclusion Criteria:

- Patients undergoing peritoneal dialysis