Perioperative risks of bariatric surgery among patients with and without history of solid organ transplant. Issue 9 (8th May 2020)

• Record Type: Journal Article
• Authors: Montgomery, John R.; Cohen, Jordan A.; Brown, Craig S.; Sheetz, Kyle H.; Chao, Grace F.; Waits, Seth A.; Telem, Dana A.
• Is Part Of: American journal of transplantation. Volume 20:Issue 9(2020)
• Page Start: 2530
• Page End: 2539
• Publication Date: 2020-05-08
• Subjects: complication: medical/metabolic -- complication: surgical/technical -- health services and outcomes research -- kidney disease -- obesity -- organ transplantation in general -- registry/registry analysis; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.15883
• Languages: English
• ISSNs: 1600-6135

Abstract

Abstract : 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 US bariatric procedures. All primary, laparoscopic sleeve gastrectomy and Roux‐en‐Y gastric bypass procedures between 2017 and 2018 were identified from the MBSAQIP dataset. Patients with previous transplant (n = 610) were compared with 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 estimated glomerular filtration rate was found to be a strong moderator of primary outcomes, with the highest risk of complications occurring at the lowest baseline estimated glomerular filtration rate. 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. Abstract : The authors show that transplant recipients who undergo bariatric surgery experience a higher incidence of readmission and surgical and medical complications than nontransplant patients but suggest that these increased risks are not prohibitive.