Effect of immunosuppressive agents on bariatric surgery: a systematic review

Bariatric surgery is a well-established treatment for obesity and its associated co-morbidities. The impact of immunosuppressive therapy on patients undergoing bariatric surgery remains poorly understood although it has been associated with higher infection rates, poor wound healing, and anastomotic leakage. Evidence on the effect of immunosuppressive agents on bariatric surgery is warranted to optimize patient care and surgical success. We aimed to evaluate the impact of immunosuppressive agents on weight loss outcomes and complication rates after common bariatric procedures. A systematic review was conducted across PubMed, Google Scholar, Medline, and Embase since December 2013 using keywords related to immunosuppressive agents and bariatric surgery to select primary, peer-reviewed studies for analysis. Thirty-three studies met inclusion criteria. Immunosuppressive agents analyzed included corticosteroids, disease-modifying antirheumatic drugs, biologic agents, and calcineurin inhibitors across various bariatric procedures. Immunosuppressive conditions consisted of inflammatory bowel disease in 3 studies, solid organ transplant in 21 studies, rheumatoid arthritis in 3 studies, systemic lupus erythematosum in 1 study, and 6 studies with an unspecified immunosuppressive agent, most commonly corticosteroids. Immunosuppressive agents were associated with higher postoperative complication rates after bariatric surgery; however, weight loss outcomes and metabolic improvements remained consistent with established literature. Sleeve gastrectomy (SG) is safe in immunosuppressed patients; however, consideration of individual patient profile is important in procedural planning and selection. Large-scale prospective research is required to substantiate the evidence for procedural selection and the effects of individual immunosuppressive agents.