Impact of Bariatric Surgery on Post-Transplant Outcomes in Solid Organ Recipients: A Retrospective Cohort Study

Background/Objectives: Obesity affects over 40% of solid organ transplant candidates, increasing graft complications. Bariatric surgery remains underutilized in this population due to safety concerns. We sought to evaluate predictors of graft success among patients with and without a history of bariatric surgery. Methods: We utilized the Nationwide Inpatient Sample (2015-2020) to identify adult solid organ transplant recipients with or without a history of bariatric surgery. Propensity score matching (2:1) was performed. The primary outcome was a composite of graft-related complications, including acute or chronic rejection, graft failure, and organ-specific transplant complications. Results: Among 196,871 transplant recipients, 2670 (1.4%) had a bariatric surgery history. After matching, 2530 bariatric surgery patients (age 55.6 ± 11.3 years, 37.5% female, 29.0% obese) were compared with 4817 controls (age 56.3 ± 13.9 years, 36.0% female. 29.1% obese). Bariatric surgery patients had significantly lower composite graft complications (7.7% vs. 10.5%; p < 0.001), driven by reductions in chronic graft rejection (2.1% vs. 3.1%; p = 0.01), kidney complications (6.2% vs. 8.4%; p < 0.001), and pancreas complications (0.2% vs. 0.6%; p = 0.004). Multivariate analysis showed bariatric surgery was independently associated with 23% reduced odds of graft complications (OR 0.77; 95% CI 0.61-0.96; p = 0.02). Conclusions: Bariatric surgery was independently associated with reduced graft-related complications in solid organ transplant recipients, supporting its role in improving post-transplant outcomes. Future studies should define the optimal timing of bariatric surgery relative to transplantation.