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World J Diabetes. Sep 15, 2021; 12(9): 1563-1575
Published online Sep 15, 2021. doi: 10.4239/wjd.v12.i9.1563
Obesity and bariatric surgery in kidney transplantation: A clinical review
Massimiliano Veroux, Edoardo Mattone, Matteo Cavallo, Rossella Gioco, Daniela Corona, Alessio Volpicelli, Pierfrancesco Veroux
Massimiliano Veroux, Department of Medical and Surgical Sciences and Advanced Technologies GF Ingrassia, University of Catania, Catania 95123, Italy
Edoardo Mattone, Matteo Cavallo, Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Catania 95123, Italy
Rossella Gioco, Daniela Corona, Alessio Volpicelli, General Surgery Unit, University Hospital of Catania, Catania 95123, Italy
Pierfrancesco Veroux, Department of General Surgery and Medical Specialities, University of Catania, Catania 95123, Italy
Author contributions: Veroux M and Mattone E had the idea for the review; Mattone E, Cavallo M, Gioco R, Volpicelli A and Corona D performed the literature search and data analysis; Mattone E, Cavallo M and Veroux M made the original draft preparation of the manuscript; Veroux M and Veroux P critically revised the manuscript.
Supported by FIR-14 Research Project of the University of Catania.
Conflict-of-interest statement: The authors declare no conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Massimiliano Veroux, MD, PhD, Associate Professor, Surgeon, Department of Medical and Surgical Sciences and Advanced Technologies GF Ingrassia, University of Catania, Via Santa Sofia 84, Catania 95123, Italy. veroux@unict.it
Received: April 29, 2021
Peer-review started: April 29, 2021
First decision: June 16, 2021
Revised: June 30, 2021
Accepted: August 9, 2021
Article in press: August 9, 2021
Published online: September 15, 2021
Processing time: 130 Days and 16 Hours
Abstract

Obesity is increasing worldwide, and this has major implications in the setting of kidney transplantation. Patients with obesity may have limited access to transplantation and increased posttransplant morbidity and mortality. Most transplant centers incorporate interventions aiming to target obesity in kidney transplant candidates, including dietary education and lifestyle modifications. For those failing nutritional restriction and medical therapy, the use of bariatric surgery may increase the transplant candidacy of patients with obesity and end-stage renal disease (ESRD) and may potentially improve the immediate and late outcomes. Bariatric surgery in ESRD patients is associated with weight loss ranging from 29.8% to 72.8% excess weight loss, with reported mortality and morbidity rates of 2% and 7%, respectively. The most commonly performed bariatric surgical procedures in patients with ESRD and in transplant patients are laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass. However, the correct timing of bariatric surgery and the ideal type of surgery have yet to be determined, although pretransplant LSG seems to be associated with an acceptable risk-benefit profile. We review the impact of obesity on kidney transplant candidates and recipients and in potential living kidney donors, exploring the potential impact of bariatric surgery in addressing obesity in these populations, thereby potentially improving posttransplant outcomes.

Keywords: End-stage renal disease; Living donor; Gastric bypass; Sleeve gastrectomy; Waiting list; Deceased donor

Core Tip: Many studies demonstrated that obese patients may have limited access to kidney transplantation and an increased rate of posttransplant complications. Diet and lifestyle modifications may have a limited impact in the treatment of obesity in these patients, while bariatric surgery has the potential to improve the candidacy of these patients and to improve perioperative outcomes. This review will evaluate the potential role of bariatric surgery in the setting of kidney transplantation.