Metabolic and Bariatric Operation and the Path to Kidney Transplantation.

BACKGROUND

Obesity is a significant barrier to kidney transplantation for patients with end-stage renal disease (ESRD). We aimed to evaluate the long-term impact of metabolic and bariatric surgery (MBS) on kidney transplantation access and outcomes in individuals with obesity and patients with ESRD.

STUDY

DESIGN

A retrospective cohort study using data from 64 US healthcare organizations included 132,989 individuals with obesity (BMI ≥ 30 kg/m²) and ESRD requiring dialysis, of whom 6,263 (4.6%) underwent MBS. Propensity score matching produced 1:1 matched groups of 6,238 patients each, analyzed for 10 years. Primary outcomes included rates of kidney transplant waitlist placement, transplantation, and overall mortality. Secondary outcomes focused on 22,979 transplant recipients, including 1,701 (7.4%) patients who underwent MBS, to evaluate posttransplant adverse events.

RESULTS

During a median follow-up of 33.3 months (MBS) and 28.5 months (controls), patients who underwent MBS demonstrated higher rates of waitlist placement (19.12% vs 10.53%, hazard ratio [HR] 1.800, 95% CI 1.636 to 1.980, p < 0.001) and transplantation (27.06% vs 16.09%, HR 1.712, 95% CI 1.584 to 1.852, p < 0.001) at 10 years, with benefits evident within 1-month postoperation. Mortality was lower in the MBS group (30.55% vs 36.44%, HR 0.768, 95% CI 0.723 to 0.817, p < 0.001). In transplant recipients, patients who underwent MBS had lower cardiovascular complications (37.3% vs 40.6%, risk ratio 0.92, p = 0.007) and all-cause mortality (16.70% vs 20.88%, HR 0.82, p < 0.001), with no significant differences in graft rejection or failure.

CONCLUSIONS

MBS significantly improves access to kidney transplantation and long-term survival for obese patients with ESRD. Patients who underwent MBS demonstrated notable improvements in cardiovascular health, potentially leading to a better quality of life and survival. These findings suggest that MBS should be considered as part of the comprehensive care for this high-risk population.