Comparable Outcomes Following Bariatric Surgery Before or After Kidney Transplantation Support Individualized...

Area of Science:

• Nephrology
• Bariatric Surgery
• Transplant Surgery

Background:

• Obesity and end-stage kidney disease (ESKD) pose complex challenges.
• Metabolic and bariatric surgery (MBS) improves kidney transplant (KTx) access and outcomes.
• The optimal timing of MBS relative to KTx is debated.

Purpose of the Study:

• To compare patient outcomes based on the sequence of MBS and KTx.
• To guide individualized surgical planning for patients with obesity and ESKD.

Main Methods:

• Single-center retrospective cohort study (2012-2023).
• Identified adult patients who underwent both MBS and KTx.
• Evaluated outcomes based on operative sequence: MBS-first vs. KTx-first.

Main Results:

• Twenty patients included (11 KTx-first, 9 MBS-first).
• MBS-first cohort had lower pre-transplant BMI (31.9 vs. 38.1 kg/m²).
• Similar 1-year weight loss and 4.6-year graft survival (80%) between groups.
• No significant differences in perioperative events or graft outcomes observed.

Conclusions:

• Operative sequencing of MBS and KTx did not yield significant differences in key outcomes.
• Individualized surgical timing may be appropriate based on patient-specific factors.
• Multidisciplinary care is crucial for optimizing patient management.