Patients with class II and III obesity and end-stage renal disease are often ineligible for kidney transplantation (KTx) due to increased postoperative complications and technically challenging surgery. Bariatric surgery (BS) can be an effective solution for KTx candidates who are considered inoperable. The aim of this study is to evaluate outcomes of KTx after BS and to compare the outcomes to obese recipients (BMI ≥ 35 kg/m2) without BS. This retrospective, single-center study included patients who received KTx after BS between January 1994 and December 2018. The primary outcome was postoperative complications. The secondary outcomes were graft and patient survival. In total, 156 patients were included, of whom 23 underwent BS prior to KTx. There were no significant differences in postoperative complications. After a median follow-up of 5.1 years, death-censored graft survival, uncensored graft survival, and patient survival were similar to controls (log rank test p =.845,.659, and.704, respectively). Dialysis pre-transplantation (Hazard Ratio (HR) 2.55; 95%CI 1.03–6.34, p =.043) and diabetes (HR 2.41; 95%CI 1.11–5.22, p =.027) were independent risk factors for all-cause mortality. A kidney from a deceased donor was an independent risk factor for death-censored graft loss (HR 1.98; 95%CI 1.04–3.79, p =.038). Patients who received a KTx after BS have similar outcomes as obese transplant recipients.

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Clinical Transplantation
Department of Surgery

Outmani, L., Kimenai, H., Roodnat, J., Leeman, M., Biter, U.L. (Ulas L.), Klaassen, R., … Minnee, R. C. (2021). Clinical outcome of kidney transplantation after bariatric surgery: A single-center, retrospective cohort study. Clinical Transplantation. doi:10.1111/ctr.14208