Bariatric surgery has been shown to be safe in the dialysis population. Whether bariatric surgery before kidney transplantation influences post-transplant outcomes has not been examined nationally. We included severely obese (BMI>35) dialysis patients between 18-70 years who received a kidney transplant according to the US Renal Data System. We determined the association between history of bariatric surgery and risk of 30-day readmission, graft failure, or death after transplantation using multivariable logistic, Cox, and Fine-Gray models. We included 12,573 patients, of whom 503 (4%) received bariatric surgery before transplantation. Median age at transplant was 53 years; 42% were women. History of bariatric surgery was not statistically significantly associated with graft failure (HR 1.02;95% CI 0.77-1.35) or death (HR 1.10;95% CI 0.84-1.45). However, sleeve gastrectomy (vs. no bariatric surgery) was associated with lower risk of graft failure (HR 0.39;95% CI 0.16-0.95). Overall, history of bariatric surgery prior to kidney transplantation was not associated with allograft or patient survival, but findings varied by surgery type. Sleeve gastrectomy was associated with better graft survival and should be considered in severely obese transplant candidates receiving dialysis.
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