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Perioperative risks of bariatric surgery among patients with and without history of solid organ transplantation

John R Montgomery, Jordan A Cohen, Craig A Brown, Kyle H Sheetz, Grace F Chao, Seth A Waits, Dana A Telem
American Journal of Transplantation 2020 April 3
32243667
Bariatric surgery is effective among patients with previous transplant in limited case series. However, the perioperative safety of bariatric surgery in this patient population is poorly understood. Therefore, we assessed the safety of bariatric surgery among previous-transplant patients using a database that captures >92% of all U.S. bariatric procedures. All primary, laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass procedures between 2017-2018 were identified from the MBSAQIP dataset. Patients with previous transplant (n=610) were compared to patients without previous transplant (n=321,447). Primary outcomes were 30-day readmissions, surgical complications, medical complications, and death. Multivariable logistic regression with predictive margins was used to compare outcomes. Previous transplant patients experienced higher incidence of readmissions (8.0% vs 3.5%), surgical complications (5.0% vs 2.7%), and medical complications (4.3% vs 1.5%). There was no difference in incidence of death (0.2% vs 0.1%). Among individual complications, there no statistical differences in intraabdominal leak, unplanned reoperation, myocardial infarction, or infectious complications. Baseline eGFR was found to be a strong moderator of primary outcomes, with the highest risk of complications occurring at the lowest baseline eGFR. Given the many long-term benefits of bariatric surgery among patients with previous transplant, our findings should not preclude this patient population from operative consideration.

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