Bariatric surgery in posttransplantat patients: does diabetes influence outcomes?

BACKGROUND: Type 2 diabetes (T2D) is frequently present in Metabolic and Bariatric Surgery (MBS) patients and is associated with increased morbidity and mortality. Organ transplantation patients also suffer from severe obesity and are now increasingly undergoing MBS.

OBJECTIVE: To determine the association of T2D and perioperative outcomes after MBS in previous solid organ transplantation patients SETTING: University Hospital, United States.

METHODS: Patients with a history of solid organ transplantation undergoing sleeve gastrectomy and Roux-en-Y gastric bypass were identified from the 2017 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. Patients were then stratified by a history of T2D. Propensity-score matching was performed between the 2 cohorts. Outcomes were compared by Mann-Whitney U, Χ2 , and multivariable logistic regression analysis for overall and morbidity related to MBS.

RESULTS: Before matching 338 patients with a prior history of solid organ transplantation were identified including 132 (39%) with and 206 (61%) without diabetes. There were no significant differences in outcomes between the 2 cohorts at baseline, but these patients were significantly different at baseline. After matching, 85 patients with and without T2D were identified. Overall and morbidity related to MBS were similar (P > .5). Furthermore, multivariable logistic regression revealed T2D to not have an increased risk for overall (odds ratio .95, P = .09) or morbidity related to MBS (odds ratio .92, P = .87).

CONCLUSION: MBS in T2D patients with previous solid organ transplantation is overall safe with low rates of morbidity and mortality. Diabetes was not an independent predictor of adverse outcomes in this cohort of patients. Larger cohort studies are needed.