Outcomes of Bariatric Surgery After Solid Organ Transplantation

Abstract

Purpose: Obesity is prevalent after orthotopic solid organ transplant mainly due to immunosuppressive therapy, decreased physical activity, and unbalanced diet, which leads to development or worsening of other comorbidities, such as hypertension and type 2 diabetes mellitus. Morbid obesity increases the risk of graft loss and has negative effects on postoperative morbidity and patient survival. The aim of this study was to assess the safety and effectiveness of bariatric surgery after organ transplant.

Material and methods: A retrospective analysis of patients who underwent bariatric surgery after organ transplant between July 1, 2010, and June 30, 2019, was performed. Demographics, surgical data, immunosuppressive treatment, postoperative adverse events, and weight loss were collected.

Results: Thirty-eight patients met inclusion criteria. The median (range) time between transplant and bariatric surgery was 54.3 (10.0-253.0) months. Laparoscopic sleeve gastrectomy and robotic Roux-en-Y gastric bypass were performed in 28 and 10 patients, respectively. Only 1 conversion to open procedure was required. Median length of stay was 2 days, with a 30-day adverse event rate of 23.7%. No leaks were documented. At 12-month follow-up, mean (SD) percentage excess body weight loss was 58.54 (21.91) and 68.74 (23.13) after sleeve gastrectomy and Roux-en-Y gastric bypass, respectively. Comorbidity-related medications were decreased in most patients, while transplant organ rejection occurred in 2 patients.

Conclusion: Bariatric surgery after organ transplant enables considerable postoperative weight loss and improvement of obesity-related comorbidities; however, it presents with higher morbidity.

Keywords: Bariatric surgery; Gastric bypass; Organ transplantation; Sleeve gastrectomy.