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SURGERY FOR OBESITY AND RELATED DISEASES, cilt.22, sa.1, 2026 (SCI-Expanded, Scopus)
Background: The clinical impact of metabolic and bariatric surgery (MBS) before kidney transplantation (KTx) is evolving. Methods: This was a single-center retrospective study of all adult patients between January 1, 1994, and December 31, 2024, undergoing KTx with a history of antecedent MBS. Primary outcomes included death-censored graft survival and overall patient survival. Results: Among 4538 KTx recipients, 116 (2.6%) had a history of previous MBS. Median time (interquartile range, range) between BS and KTx was 6.8 years (10.9, .3-45.5). Of these, patients underwent Roux-en-Y gastric bypass (RYGB, n = 77, 66.4%), vertical sleeve gastrectomy (VSG, n = 23, 19.8%), gastric banding (n = 6, 5.2%), vertical banded gastroplasty (n = 5, 4.3%), jejunoileal bypass (n = 3, 2.6%), and duodenal switch (n = 2, 1.7%). The type of MBS (VSG versus RYGB) did not impact long-term outcomes. In total, 28 (24.1%) patients underwent planned BS with the specific intention of reaching an acceptable body mass index (BMI) threshold for KTx. Median time between BS and KTx for these patients was 1.1 years (1.3, .3-4.7). Nine patients underwent RYGB, and 19 underwent VSG. Median BMI (IQR) was reduced from 43.8 kg/m2 (6.9) at time of MBS to 32.1 kg/m2 (7.3) at time of KTx. One-year overall survival and death-censored graft survival were 96.4% and 100%, respectively. At median follow-up of 2.7 years, overall survival and death-censored graft survival were 85.7% and 89.3%. A propensity matched analysis revealed no differences in the rates of surgical complications after KTx among those with BS compared to matched controls without MBS. Conclusions: This study represents the largest single-center series of patients with MBS before KTx. Timing of antecedent BS and type of BS did not impact long-term graft or patient outcomes. Planned MBS with either VSG or RYGB followed by KTx in patients with an initially prohibitive BMI is associated with excellent short-and medium-term outcomes. (Surg Obes Relat Dis 2026;22:57-66.) (c) 2025 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.