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Background <p>Morbid obesity is a common barrier to kidney transplantation (KTx) for patients with end-stage renal disease (ESRD). Bariatric surgery (BS) has been proposed as a bridging strategy to enable transplant listing, but the size and quality of the supporting evidence base remain uncertain.</p> Objective <p>To synthesise the evidence on the safety of BS and its effectiveness in enabling formal listing and subsequent KTx in patients with stage 4 to 5 chronic kidney disease (CKD) or ESRD.</p> Methods <p>We performed a systematic review (PubMed and Cochrane CENTRAL; latest update May 2026) of studies enrolling adults with CKD stage 4 to 5 or ESRD who underwent BS with the explicit intention of facilitating subsequent KTx. The primary outcome was the proportion of patients formally listed or approved for KTx after BS. Secondary outcomes were perioperative complications (Clavien-Dindo ≥ III where reported), 30-day mortality, weight-loss efficacy, and actual KTx during follow-up. Per-study proportions and Wilson 95% confidence intervals were calculated. Given heterogeneity of outcome definitions, study designs, and cohort composition, the synthesis is descriptive; no pooled estimate is reported. Risk of bias was assessed with ROBINS-I or the JBI case-series checklist as appropriate.</p> Results <p>Ten studies meeting eligibility criteria contributed 232 patients to the primary analysis (eight studies, <i>n</i>= 195 reporting the listing outcome). Per-study listing proportions ranged from 55.8% (Freeman 2015 institutional BMI-target surrogate) to 100% (Matar 2026 planned-MBS subgroup) with most studies clustering between 56% and 76%. Perioperative Clavien-Dindo ≥ III complications occurred in 0 to 11.8% of patients across the studies that graded events explicitly. There was no perioperative (30-day) mortality in any of the 10 included cohorts. Subsequent KTx during follow-up was reported in 25 to 100% of cohorts where transplantation was an outcome. Where matched comparisons were performed (Gaillard 2020 ; Dobrzycka 2020 ; Zahran 2025 ; Matar 2026 ), post-transplant outcomes including graft function and survival were comparable between bariatric and non-bariatric recipients.</p> Conclusions <p>BS in patients with advanced CKD or ESRD is associated with meaningful weight loss, improvement of obesity-related comorbidities, and acceptable safety, and a majority of patients achieve formal transplant listing or undergo KTx during medium-term follow-up. The evidence base remains dominated by small, single-centre retrospective cohorts with heterogeneous outcome definitions; pooled effect estimates are not currently justified. Larger multicentre studies with standardised outcome reporting are needed.</p>

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Bariatric Surgery as a Bridge to Kidney Transplantation in Patients with Obesity and Advanced Chronic Kidney Disease or End-Stage Renal Disease: A Systematic Review

  • 期刊论文

  • 发表日期：

    2026年7月17日

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  • Kyriakos Bananis,
  • Rahul Mor,
  • Charalampos Voros,
  • Rahi Gandhi,
  • Kasthoory Kandiah,
  • Pushpak Chaudhari,
  • Sasindran Ramar

摘要

Background

Morbid obesity is a common barrier to kidney transplantation (KTx) for patients with end-stage renal disease (ESRD). Bariatric surgery (BS) has been proposed as a bridging strategy to enable transplant listing, but the size and quality of the supporting evidence base remain uncertain.

Objective

To synthesise the evidence on the safety of BS and its effectiveness in enabling formal listing and subsequent KTx in patients with stage 4 to 5 chronic kidney disease (CKD) or ESRD.

Methods

We performed a systematic review (PubMed and Cochrane CENTRAL; latest update May 2026) of studies enrolling adults with CKD stage 4 to 5 or ESRD who underwent BS with the explicit intention of facilitating subsequent KTx. The primary outcome was the proportion of patients formally listed or approved for KTx after BS. Secondary outcomes were perioperative complications (Clavien-Dindo ≥ III where reported), 30-day mortality, weight-loss efficacy, and actual KTx during follow-up. Per-study proportions and Wilson 95% confidence intervals were calculated. Given heterogeneity of outcome definitions, study designs, and cohort composition, the synthesis is descriptive; no pooled estimate is reported. Risk of bias was assessed with ROBINS-I or the JBI case-series checklist as appropriate.

Results

Ten studies meeting eligibility criteria contributed 232 patients to the primary analysis (eight studies, n= 195 reporting the listing outcome). Per-study listing proportions ranged from 55.8% (Freeman 2015 institutional BMI-target surrogate) to 100% (Matar 2026 planned-MBS subgroup) with most studies clustering between 56% and 76%. Perioperative Clavien-Dindo ≥ III complications occurred in 0 to 11.8% of patients across the studies that graded events explicitly. There was no perioperative (30-day) mortality in any of the 10 included cohorts. Subsequent KTx during follow-up was reported in 25 to 100% of cohorts where transplantation was an outcome. Where matched comparisons were performed (Gaillard 2020 ; Dobrzycka 2020 ; Zahran 2025 ; Matar 2026 ), post-transplant outcomes including graft function and survival were comparable between bariatric and non-bariatric recipients.

Conclusions

BS in patients with advanced CKD or ESRD is associated with meaningful weight loss, improvement of obesity-related comorbidities, and acceptable safety, and a majority of patients achieve formal transplant listing or undergo KTx during medium-term follow-up. The evidence base remains dominated by small, single-centre retrospective cohorts with heterogeneous outcome definitions; pooled effect estimates are not currently justified. Larger multicentre studies with standardised outcome reporting are needed.