Related Experiment Video
Updated: Aug 7, 2026
Robot-Assisted Kidney Transplantation
Published on: July 19, 2021
Safety and Effectiveness of Metabolic and Bariatric Surgery Before and After Kidney Transplantation: A Systematic
Guzinayi Abudukadi1, Zhi-Hao Song1, Yilizhati Azhati1
1First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China.
Background:
Kidney transplantation is the optimal treatment for end-stage kidney disease. However, obesity limits access to and success of this procedure. While metabolic and bariatric surgery (MBS) can address obesity, its safety and effectiveness in transplant candidates and recipients have not been fully elucidated.
Methods:
This systematic review and meta-analysis aimed to evaluate the safety and effectiveness of MBS performed in relation to kidney transplantation. Six databases were searched up to February 2, 2026. Randomized clinical trials and observational studies from any geographic region investigating MBS in adult kidney transplant candidates or recipients were included.
Results:
A total of 49 studies (1504 patients) were included. For pre-transplant surgery (1215 patients), the pooled observed waitlisting rate was 78.0% (95% CI 66.0-88.0%; I²=90.3%; based on 26 studies comprising 719 patients), the observed transplantation rate was 52.0% (95% CI 36.0-68.0%; I²=96.3%; based on 32 studies comprising 1249 patients), and the 1-year graft survival rate was > 99% (95% CI 98%-100%; I²=17.5%; based on 11 studies comprising 232 patients). For post-transplant surgery (289 patients), the diabetes improvement rate was 93% (95% CI 64-100%; I²=21.4%; based on 4 studies comprising 52 patients) and the hypertension improvement rate was 92% (95% CI 54-100%; I²=52.7%; based on 3 studies comprising 38 patients) (defined as medication reduction/cessation or improvement in HbA1c/blood pressure). Waitlisting rates varied significantly by country (P < 0.001) but not by procedure type (P = 0.09). Formal tests did not detect small-study effects where assessable, but power was limited and selective outcome reporting remains possible. High heterogeneity limits generalizability.
Conclusion:
In selected patients with severe obesity, pre-transplant MBS was associated with transplantation access, and post-transplant surgery with metabolic improvement in small cohorts. Observed complication rates were acceptable, but controlled studies are needed. Because the evidence is predominantly observational and heterogeneous, comparative safety and long-term graft effects remain uncertain.
Insights
Metabolic and bariatric surgery (MBS) in kidney transplant candidates and recipients shows promise for improving transplant access and metabolic health. However, more controlled studies are needed to confirm safety and long-term graft outcomes due to current evidence limitations.
Area of Science:
- Nephrology
- Transplant Surgery
- Bariatric Surgery
Background:
- Obesity is a significant barrier to kidney transplantation access and success.
- Metabolic and bariatric surgery (MBS) can manage obesity but its role in kidney transplant patients is not well-defined.
Purpose of the Study:
- To systematically review and meta-analyze the safety and effectiveness of MBS in kidney transplant candidates and recipients.
- To evaluate MBS impact on waitlisting, transplantation rates, graft survival, and metabolic parameters.
Main Methods:
- Systematic review and meta-analysis of randomized clinical trials and observational studies.
- Searched six databases up to February 2, 2026, including adult kidney transplant candidates and recipients.
- Included 49 studies with 1504 patients.
Main Results:
- Pre-transplant MBS was associated with a 78% waitlisting rate and 52% transplantation rate.
- Post-transplant MBS showed high improvement rates for diabetes (93%) and hypertension (92%).
- One-year graft survival exceeded 99%, with acceptable complication rates, but high heterogeneity was noted.
Conclusions:
- Pre-transplant MBS may improve access to kidney transplantation for selected obese patients.
- Post-transplant MBS can lead to metabolic improvements in small cohorts.
- Further controlled studies are essential to confirm safety and long-term graft effects due to predominantly observational and heterogeneous evidence.
Related Concept Videos
01:26Kidney Transplant II: Surgical Procedure
01:28Kidney Transplant I: Introduction
01:16Kidney Transplant III: Nursing Management
01:20Pharmacokinetics in Obese Patients: Drug Metabolism and Excretion
01:25Pharmacokinetics in Obese Patients: Drug Absorption and Distribution