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Updated: Jul 7, 2025
Robot-Assisted Kidney Transplantation
Published on: July 19, 2021
Bariatric surgery in prospective obese living kidney donors: scoping review and management decision algorithm
Filippo Paoletti1, Irene Urciuoli2, Jacopo Romagnoli3,4
1Renal Transplant Unit, Department of Medicine and Surgical Sciences A. Gemelli University Polyclinic Foundation IRCCS, Rome, Italy - filippopaoletti.an@gmail.com.
Introduction:
Global chronic kidney disease is now epidemic, with substantial health and economic consequences. While scientific support for living donor renal transplants (LDRT) is strong, donor shortages necessitate consideration of expanded criteria, including obese individuals. Bariatric surgery (BS) may mitigate obesity-related risks, but research on living donor candidates is scarce. Our scoping review aims to compile evidence, identify gaps, and formulate an algorithm to guide healthcare professionals in evaluating BS for obese living donors.
Evidence Acquisition:
We did a systematic search of studies on living kidney donors and obesity. We searched the MEDLINE Ovid, Embase Ovid, CENTRAL and Web of Science databases for studies from database inception to March 30, 2023. All English-language articles available in full text have been considered. Excluded are commentaries, editorials, letters, and abstracts.
Evidence Synthesis:
Obesity in LDRT raises long-term ESRD risk. Current high BMI donor admission raises ethical and clinical concerns. Encouraging timely weight loss can make obese candidates suitable donors, reducing risks. Sleeve gastrectomy is the most reported and preferable approach, since it minimizes hyperoxaluria risk. Re-evaluation for donation is possible 6-12 months post-BS, with BMI<35 for three months. Cost-benefit analysis favors BS over nephrectomy in obese donors (cost-benefit ratio: 3.64) when graft survival is equal.
Conclusions:
BS shows promise with short-term effectiveness and potential long-term outcomes. However, it should not be perceived as a means to expand the donor pool but rather as a personalized approach to address obesity and improve individuals' health.
Insights
Bariatric surgery can help obese living kidney donor candidates manage weight and reduce risks, making them suitable for donation. This approach offers potential long-term health benefits and is cost-effective, but should be personalized.
Area of Science:
- Nephrology
- Transplant Surgery
- Bariatric Surgery
Background:
- Chronic kidney disease (CKD) is a global epidemic with significant health and economic impacts.
- Living donor renal transplantation (LDRT) is effective, but donor shortages necessitate considering obese individuals.
- Obesity poses risks for LDRT donors, and bariatric surgery (BS) may mitigate these, yet research is limited.
Purpose of the Study:
- To conduct a scoping review of evidence regarding bariatric surgery for obese living kidney donor candidates.
- To identify research gaps in this area.
- To develop an algorithm for healthcare professionals evaluating BS in obese living donors.
Main Methods:
- Systematic literature search of MEDLINE, Embase, CENTRAL, and Web of Science databases.
- Inclusion of full-text English-language articles from database inception to March 30, 2023.
- Exclusion of commentaries, editorials, letters, and abstracts.
Main Results:
- Obesity in LDRT donors increases long-term end-stage renal disease (ESRD) risk, raising ethical and clinical concerns.
- Weight loss through BS can make obese candidates suitable donors, with sleeve gastrectomy being the preferred method due to lower hyperoxaluria risk.
- Re-evaluation for donation is possible 6-12 months post-BS if BMI remains <35 for three months; BS is cost-beneficial compared to nephrectomy.
Conclusions:
- Bariatric surgery demonstrates short-term effectiveness and potential long-term benefits for obese living kidney donor candidates.
- BS should be viewed as a personalized health improvement strategy, not solely for expanding the donor pool.
- Further research is needed to fully understand long-term outcomes and optimize BS protocols for living donors.
