Impact of Sleeve Gastrectomy on Kidney Function and Preemptive Transplant in Kidney Transplant Candidates With Obesity.

Abstract

To compare the impact of sleeve gastrectomy (SG) on kidney function, comorbidities, and kidney transplant (KT) rates in KT candidates with obesity with a nonsurgical cohort. Twenty-one KT candidates with body mass index (BMI) above 35 kg/m² underwent SG between February 26, 2021, and October 27, 2023, and were compared with 19 who did not have SG. The secondary endpoints included changes in BMI, requirements for antihyperglycemic and antihypertension medications, and preemptive KT rates. The mean estimated glomerular filtration rate (eGFR) increased from a pre-SG baseline of 16.7±5.4 to 23.5±8.3 and 23.5±8.6 mL/min per 1.73 m² at 2 and 6 months after SG (P=.002 and .02, respectively), whereas it remained unchanged in the non-SG cohort: 13.8±3.4, 14.3±5.1, and 14.8±6.4 mL/min per 1.73 m² at the pre-evaluation period, 2 months, and 6 months. A higher baseline eGFR correlated with an improvement in eGFR after SG. The BMI and insulin requirements decreased only in the SG cohort. During the follow-up period of 5.1±4.6 months, 5 (23.8%) patients in the SG cohort and no patient in the non-SG cohort underwent preemptive KT. Pretransplant SG improves kidney function and may consequently increase rates of preemptive KT in candidates not yet on dialysis. These findings need to be confirmed by prospective studies with a well-matched cohort.