Bariatric surgery improves access to renal transplantation and is safe in renal failure as well as after transplantation: A systematic review and meta-analysis

• Published in: Transplantation reviews (Philadelphia, Pa.) Pa.), 2023-07, Vol.37 (3), p.100777-100777, Article 100777
• Main Authors: Fernando, Sherwin, Varma, Jonny, Dengu, Fungai, Menon, Vinod, Malik, Shafi, O'Callaghan, John
• Format: Article
• Language: English
• Subjects: Bariatric surgery; Bariatric Surgery - adverse effects; Chronic kidney disease; Duodenal switch; End stage renal disease; Gastric banding; Gastric bypass; Humans; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - surgery; Kidney transplant waiting list; Kidney Transplantation; Obesity; Obesity, Morbid - complications; Obesity, Morbid - surgery; Renal Insufficiency - etiology; Sleeve gastrectomy; Treatment Outcome
• ISSN: 0955-470X; 1557-9816
• DOI: 10.1016/j.trre.2023.100777

Effective workup and listing of end-stage renal disease (ESRD) patients for renal transplantation, often with multiple co-morbidities, poses a challenge for transplant teams. Obesity is a common co-morbidity associated with adverse outcomes in ESRD and kidney transplant (KT) recipients. Bariatric and metabolic surgery (BMS) has long been established as a safe and effective treatment for morbid obesity. In this study, the authors aimed to evaluate the strength of evidence for both the efficacy and safety of bariatric surgery in patients with ESRD or kidney transplantation. A literature search was performed using key terms including “transplantation”, “kidney”, “renal”, “obesity”, and “bariatric”. Databases searched include MEDLINE, EMBASE and Web of Science from inception to date (April 2021). Methodological quality was assessed using the Newcastle-Ottawa tool. Selected articles were then categorised into patients awaiting waiting list acceptance, patients awaiting transplantation, patients undergoing simultaneous BMS + KT and patients undergoing BMS following a previous renal transplant. Summary effects are presented with a level of statistical significance and 95% Confidence Intervals. A total of 28 articles were selected following the literature search. Fourteen studies on patients awaiting listing (n = 1903), nine on patients on the KT waiting list (n = 196), a single study on simultaneous BMS and KT and ten studies on patients undergoing BMS following KT (n = 198). Mean change in BMI for patients awaiting listing was −11.3 kg/m2 (95%CI: −15.3 to −7.3, p