Gina B A Collaborative Transplant and Weight Loss Surgery at RWJUH

I feel like a new different person.

When Gina Bergstrom woke in February 2019 feeling unable to breathe fully or walk more than a few feet, she knew her kidneys were the culprit.

A dozen years earlier, undetected and untreated high blood pressure had damaged the Sayreville woman’s kidneys, causing problems similar to those she was experiencing in 2019. Bergstrom’s symptoms had improved after she was prescribed medication. But over time, her kidney function had gradually continued to dwindle. Now she was facing dialysis treatments to artificially purify her blood three times a week.

Doctors at Robert Wood Johnson University Hospital (RWJUH) told Bergstrom she’d need a kidney transplant. But first she would need to lose at least 60 of her then 260 pounds to become eligible for a place on the organ transplant list. It was a moment of clarity for Bergstrom, who had struggled with excess weight for many years.

“When my mother was shown to be an organ match, I decided if I had to stand on my head 23 hours and 59 minutes a day to get and keep the new kidney, that’s what I was going to do,” recalls Bergstrom, who was 51 at the time. “I worked my backside off and was exactly 200 pounds on the day of the surgery.”

Team Approach

RWJUH surgeons faced an unusual case with Bergstrom’s then-67-year-old mother as her organ donor.

“Because kidney failure is typically an older-age disease, it’s more common that a child will donate to a parent,” says Director of Transplantation Ronald Pelletier, MD, who operated on Bergstrom’s mother, Jennie Montanino of West Palm Beach, FL. But Bergstrom was fortunate. “Having a living donor available is best, because the average wait time for a deceased-donor kidney transplant in New Jersey runs about seven years,” Dr. Pelletier says.

Bergstrom’s weight was an issue because obesity can be associated with increased risk of complications after transplant. About 20 percent of RWJUH patients evaluated each year for organ transplants are overweight or obese, reflecting broader national numbers, says transplant surgeon Advaith Bongu, MD, who successfully transplanted Bergstrom’s new kidney in December 2019.

This led RWJUH to create a unique collaboration between the transplant and bariatric, or weight loss, surgery programs. The partnership is designed to benefit high-risk patients who would otherwise not be candidates or those like Bergstrom who have regained weight post-transplant due to medications. Dr. Bongu suggested she meet with the bariatric team to discuss her options.

“It can be scary for patients: You sign up for one surgery and all of a sudden you’re talking about two potential surgeries,” Dr. Bongu says. “But weight loss surgery is generally safe and potentially beneficial, so Gina wanted to move forward.”

“I knew it would help me in the long run,” Bergstrom says. “I wanted to do everything I could to help myself.”

Reducing Risks

The minimally invasive bariatric procedure, performed in January 2021, involved reducing the size of Bergstrom’s stomach so she would feel full after eating even small amounts.

“Our operation basically protected her transplanted kidney by lowering risks from obesity-related factors such as high blood pressure and high cholesterol as well as obesity itself that may have predisposed her to organ rejection,” says Ragui Sadek, MD, Director of Metabolic and Bariatric Surgery. RWJUH is a designated Center of Excellence in Bariatric Surgery.

“Gina’s case shows two sides of what we do here,” Dr. Sadek says. “Before an operation, we can bring a patient’s weight down to make them a candidate for transplant. Or if they had a transplant and gained weight afterward because of medications or other reasons, we can often correct certain medical conditions that may jeopardize the transplanted kidney.”

After recovering from both surgeries, Bergstrom says she feels “like a new, different person.” Before her transplant, limitations that her impaired kidneys imposed made it impossible to help care for her two young nephews. Now with her new kidney and a weight of 121 pounds, the doting aunt easily treks the two-plus miles to her nephews’ school as well as to local stores. Bergstrom’s body mass index (BMI), a measure of body fat based on height and weight, has dropped into the normal range, Dr. Sadek says.

“I do a lot of walking and eat a lot of protein, vegetables and other healthy foods,” says Bergstrom, who needs to take anti-rejection medications and special vitamins. “Now my family yells at me to sit still, but I’ve got so much energy, I always have to be doing something.”

“Gina went from being morbidly obese with coexisting conditions to not even being overweight,” Dr. Sadek says. “She had two operations at RWJUH that literally saved her life and likely added at least 10 years to her life expectancy.”

To learn more about kidney transplantation and factors affecting eligibility such as weight at Robert Wood Johnson University Hospital, call 732.828.3000 or visit our website.