Background: Obesity is a major risk factor for transplant. Laparoscopic bariatric surgery (LBS) offers transplant patient benefits including improved comorbidities, graft function, and longevity. We completed a scoping review and analyzed the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) to determine the risk-benefit profile of LBS after transplant. We also compared laparoscopic sleeve gastrectomy (LSG) to laparoscopic Roux-en-Y gastric bypass (LRYGB) following transplant.
Methods: Univariate analysis determined between group differences with subgroup analysis comparing LSG versus LRYGB in transplant patients. Multivariable analysis assessed whether prior transplant was independently associated with major complications or mortality.
Results: A total of 469 (0.1%) patients had previous transplant and had more comorbidities and more often underwent LSG. Operative time (93.9 min vs 83 min, p < 0.001) and length of stay were longer. Major complications were threefold higher in patients with a transplant history (9.6% vs 3.2%; p < 0.001. Previous transplant was the second greatest independent predictor for major complication (OR 2.14 [1.54-2.98], p = < 0.001) but was not predictive of death (OR 1.06 [0.14-8.13] p = 0.956). Amongst transplant patients, LRYGB demonstrated higher rates of leak (n = 1), VTE, AKI, unplanned intubation, and readmission.
Conclusions: The 30-day complication rate from LBS is three times higher amongst patients with a transplant. LSG is likely the best surgical approach. Despite risks, post-transplant patients incur important benefits from LBS. Surgeons must be aware of this risk-benefit profile when determining LBS candidacy.
Keywords: Bariatric surgery; Obesity; Sleeve gastrectomy; Transplant.