Bariatric Surgery and Transplantation

  • Giuseppe D’Amico
  • Kiara Tulla
  • Ivo TzvetanovEmail author


The epidemic incidence of obesity among the general population has significant impact on patients with different end-stage organ failure. On the one hand, obesity could be a major contributor for these organ dysfunctions; on the other hand, obesity prevents many patients from receiving organ transplantation. Because of the proven higher rate of complications and inferior short- and long-term results among patients with obesity, many transplant centers consider a patient’s BMI when evaluating candidacy for transplantation. Intentional weight loss as a result of application of bariatric surgery before or after organ transplantation carries significant potential to improve the likelihood many patients can receive lifesaving transplants. Furthermore, this change in patient biology could improve the long-term graft function along with patient survival.


Liver transplantation Kidney transplantation Pancreas transplantation Organ transplantation Obesity Bariatric surgery Health disparities 




Adjustable gastric banding


Body mass index


Bariatric surgery


Duodenal switch


Excess weight-loss


End-stage renal disease


Kidney transplant


Laparoscopic gastric bypass


Laparoscopic sleeve gastrectomy


Liver transplant


Metabolic syndrome


Medically supervised weight loss


Pancreas after kidney transplant


Pancreas transplant


Pancreas transplant alone


Roux-en-Y gastric bypass


Sleeve gastrectomy


Simultaneous pancreas kidney transplant


Type 1 diabetes mellitus


Type 2 diabetes mellitus


  1. 1.
    Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384(9945):766–81.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Wang Y, Beydoun MA, Liang L, Caballero B, Kumanyika SK. Will all Americans become overweight or obese? Estimating the progression and cost of the US obesity epidemic. Obesity (Silver Spring). 2008;16(10):2323–30.CrossRefGoogle Scholar
  3. 3.
    Friedman AN, Miskulin DC, Rosenberg IH, Levey AS. Demographics and trends in overweight and obesity in patients at time of kidney transplantation. Am J Kidney Dis. 2003;41(2):480–7.CrossRefPubMedGoogle Scholar
  4. 4.
    Charlton MR, Burns JM, Pedersen RA, Watt KD, Heimbach JK, Dierkhising RA. Frequency and outcomes of liver transplantation for nonalcoholic steatohepatitis in the United States. Gastroenterology. 2011;141(4):1249–53.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Redfield RR, Rickels MR, Naji A, Odorico JS. Pancreas transplantation in the modern era. Gastroenterol Clin N Am. 2016;45(1):145–66.CrossRefGoogle Scholar
  6. 6.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.CrossRefPubMedGoogle Scholar
  7. 7.
    Kopelman PG. Obesity as a medical problem. Nature. 2000;404(6778):635–43.CrossRefPubMedGoogle Scholar
  8. 8.
    Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: a systematic and clinical review. JAMA. 2014;311(1):74–86.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Halperin F, Ding SA, Simonson DC, et al. Roux-en-Y gastric bypass surgery or lifestyle with intensive medical management in patients with type 2 diabetes: feasibility and 1-year results of a randomized clinical trial. JAMA Surg. 2014;149(7):716–26.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Colquitt JL, Pickett K, Loveman E, Frampton GK. Surgery for weight loss in adults. Cochrane Database Syst Rev. 2014;8:CD003641.Google Scholar
  11. 11.
    LaMattina JC, Foley DP, Fernandez LA, et al. Complications associated with liver transplantation in the obese recipient. Clin Transpl. 2012;26(6):910–8.CrossRefGoogle Scholar
  12. 12.
    Dick AA, Spitzer AL, Seifert CF, et al. Liver transplantation at the extremes of the body mass index. Liver Transpl. 2009;15(8):968–77.CrossRefPubMedGoogle Scholar
  13. 13.
    Nair S, Verma S, Thuluvath PJ. Obesity and its effect on survival in patients undergoing orthotopic liver transplantation in the United States. Hepatology. 2002;35(1):105–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Hakeem AR, Cockbain AJ, Raza SS, et al. Increased morbidity in overweight and obese liver transplant recipients: a single-center experience of 1325 patients from the United Kingdom. Liver Transpl. 2013;19(5):551–62.CrossRefPubMedGoogle Scholar
  15. 15.
    Perez-Protto SE, Quintini C, Reynolds LF, et al. Comparable graft and patient survival in lean and obese liver transplant recipients. Liver Transpl. 2013;19(8):907–15.CrossRefPubMedGoogle Scholar
  16. 16.
    Pelletier SJ, Maraschio MA, Schaubel DE, et al. Survival benefit of kidney and liver transplantation for obese patients on the waiting list. Clin Transpl. 2003;(1):77–88.Google Scholar
  17. 17.
    Conzen KD, Vachharajani N, Collins KM, et al. Morbid obesity in liver transplant recipients adversely affects long-term graft and patient survival in a single-institution analysis. HPB (Oxford). 2015;17(3):251–7.CrossRefGoogle Scholar
  18. 18.
    Lin MY, Tavakol MM, Sarin A, et al. Laparoscopic sleeve gastrectomy is safe and efficacious for pretransplant candidates. Surg Obes Relat Dis. 2013;9(5):653–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Takata MC, Campos GM, Ciovica R, et al. Laparoscopic bariatric surgery improves candidacy in morbidly obese patients awaiting transplantation. Surg Obes Relat Dis. 2008;4(2):159–64; discussion 164–155.CrossRefPubMedGoogle Scholar
  20. 20.
    Taneja S, Gupta S, Wadhawan M, Goyal N. Single-lobe living donor liver transplant in a morbidly obese cirrhotic patient preceded by laparoscopic sleeve gastrectomy. Case Rep Transplant. 2013;2013:279651.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Duchini A, Brunson ME. Roux-en-Y gastric bypass for recurrent nonalcoholic steatohepatitis in liver transplant recipients with morbid obesity. Transplantation. 2001;72(1):156–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Lin MY, Tavakol MM, Sarin A, et al. Safety and feasibility of sleeve gastrectomy in morbidly obese patients following liver transplantation. Surg Endosc. 2013;27(1):81–5.CrossRefPubMedGoogle Scholar
  23. 23.
    Tichansky DS, Madan AK. Laparoscopic Roux-en-Y gastric bypass is safe and feasible after orthotopic liver transplantation. Obes Surg. 2005;15(10):1481–6.CrossRefPubMedGoogle Scholar
  24. 24.
    Campsen J, Zimmerman M, Shoen J, et al. Adjustable gastric banding in a morbidly obese patient during liver transplantation. Obes Surg. 2008;18(12):1625–7.CrossRefPubMedGoogle Scholar
  25. 25.
    Heimbach JK, Watt KD, Poterucha JJ, et al. Combined liver transplantation and gastric sleeve resection for patients with medically complicated obesity and end-stage liver disease. Am J Transplant. 2013;13(2):363–8.CrossRefPubMedGoogle Scholar
  26. 26.
    Holley JL, Shapiro R, Lopatin WB, Tzakis AG, Hakala TR, Starzl TE. Obesity as a risk factor following cadaveric renal transplantation. Transplantation. 1990;49(2):387–9.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Ditonno P, Lucarelli G, Impedovo SV, et al. Obesity in kidney transplantation affects renal function but not graft and patient survival. Transplant Proc. 2011;43(1):367–72.CrossRefPubMedGoogle Scholar
  28. 28.
    Singh D, Lawen J, Alkhudair W. Does pretransplant obesity affect the outcome in kidney transplant recipients? Transplant Proc. 2005;37(2):717–20.CrossRefPubMedGoogle Scholar
  29. 29.
    Lynch RJ, Ranney DN, Shijie C, Lee DS, Samala N, Englesbe MJ. Obesity, surgical site infection, and outcome following renal transplantation. Ann Surg. 2009;250(6):1014–20.CrossRefPubMedGoogle Scholar
  30. 30.
    Meier-Kriesche HU, Vaghela M, Thambuganipalle R, Friedman G, Jacobs M, Kaplan B. The effect of body mass index on long-term renal allograft survival. Transplantation. 1999;68(9):1294–7.CrossRefPubMedGoogle Scholar
  31. 31.
    Meier-Kriesche HU, Arndorfer JA, Kaplan B. The impact of body mass index on renal transplant outcomes: a significant independent risk factor for graft failure and patient death. Transplantation. 2002;73(1):70–4.CrossRefPubMedGoogle Scholar
  32. 32.
    Molnar MZ, Kovesdy CP, Mucsi I, et al. Higher recipient body mass index is associated with post-transplant delayed kidney graft function. Kidney Int. 2011;80(2):218–24.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Chang SH, Coates PT, McDonald SP. Effects of body mass index at transplant on outcomes of kidney transplantation. Transplantation. 2007;84(8):981–7.CrossRefPubMedGoogle Scholar
  34. 34.
    Armstrong KA, Campbell SB, Hawley CM, Johnson DW, Isbel NM. Impact of obesity on renal transplant outcomes. Nephrology (Carlton). 2005;10(4):405–13.CrossRefGoogle Scholar
  35. 35.
    MacLaughlin HL, Hall WL, Patel AG, et al. Weight loss, adipokines, and quality of life after sleeve gastrectomy in obese patients with stages 3-4 CKD: a randomized controlled pilot study. Am J Kidney Dis. 2014;64(4):660–3.CrossRefPubMedGoogle Scholar
  36. 36.
    Freeman CM, Woodle ES, Shi J, et al. Addressing morbid obesity as a barrier to renal transplantation with laparoscopic sleeve gastrectomy. Am J Transplant. 2015;15(5):1360–8.CrossRefPubMedGoogle Scholar
  37. 37.
    Marterre WF, Hariharan S, First MR, Alexander JW. Gastric bypass in morbidly obese kidney transplant recipients. Clin Transpl. 1996;10(5):414–9.Google Scholar
  38. 38.
    Modanlou KA, Muthyala U, Xiao H, et al. Bariatric surgery among kidney transplant candidates and recipients: analysis of the United States renal data system and literature review. Transplantation. 2009;87(8):1167–73.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Young MT, Gebhart A, Phelan MJ, Nguyen NT. Use and outcomes of laparoscopic sleeve gastrectomy vs laparoscopic gastric bypass: analysis of the American College of Surgeons NSQIP. J Am Coll Surg. 2015;220(5):880–5.CrossRefPubMedGoogle Scholar
  40. 40.
    Szomstein S, Rojas R, Rosenthal RJ. Outcomes of laparoscopic bariatric surgery after renal transplant. Obes Surg. 2010;20(3):383–5.CrossRefPubMedGoogle Scholar
  41. 41.
    Golomb I, Winkler J, Ben-Yakov A, Benitez CC, Keidar A. Laparoscopic sleeve gastrectomy as a weight reduction strategy in obese patients after kidney transplantation. Am J Transplant. 2014;14(10):2384–90.CrossRefPubMedGoogle Scholar
  42. 42.
    Ayloo SM, D’Amico G, West-Thielke P, et al. Combined robot-assisted kidney transplantation and sleeve gastrectomy in a morbidly obese recipient. Transplantation. 2015;99:1495–8.CrossRefPubMedGoogle Scholar
  43. 43.
    Lo DJ, Sayed BA, Turgeon NA. Pancreas transplantation in unconventional recipients. Curr Opin Organ Transplant. 2016;21(4):393–8.CrossRefPubMedGoogle Scholar
  44. 44.
    Bédat B, Niclauss N, Jannot AS, et al. Impact of recipient body mass index on short-term and long-term survival of pancreatic grafts. Transplantation. 2015;99(1):94–9.CrossRefPubMedGoogle Scholar
  45. 45.
    Sampaio MS, Reddy PN, Kuo HT, et al. Obesity was associated with inferior outcomes in simultaneous pancreas kidney transplant. Transplantation. 2010;89(9):1117–25.CrossRefPubMedGoogle Scholar
  46. 46.
    Porubsky M, Powelson JA, Selzer DJ, et al. Pancreas transplantation after bariatric surgery. Clin Transpl. 2012;26(1):E1–6.CrossRefGoogle Scholar
  47. 47.
    Elli EF, Gonzalez-Heredia R, Sanchez-Johnsen L, Patel N, Garcia-Roca R, Oberholzer J. Sleeve gastrectomy surgery in obese patients post-organ transplantation. Surg Obes Relat Dis. 2016;12(3):528–34.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Giuseppe D’Amico
    • 1
  • Kiara Tulla
    • 1
  • Ivo Tzvetanov
    • 1
    Email author
  1. 1.Department of SurgeryUniversity of Illinois at ChicagoChicagoUSA

Personalised recommendations