Can Metabolic Surgery Be Used to Improve Access to and Outcomes of Kidney Transplantation?

Obesity is common in people with chronic kidney disease (CKD) (1) and associated with a higher risk of kidney allograft complications (2); thus, BMIs 35 kg/m2 and 40 kg/m2 are generally considered relative and absolute contraindications to kidney transplantation (2). Metabolic surgery improves renal outcomes in patients with type 2 diabetes (3) and diabetes is an important risk factor for renal functional decline after kidney transplantation, raising the possibility that metabolic surgery may improve graft survival and mortality in this setting (2). An understanding of the efficacy and safety of metabolic surgery in people with end-stage kidney disease (ESKD) and in kidney transplant recipients is required.