Morbidity and mortality rates continue to improve in bariatric surgery patients, and higher risk patients are now able to undergo weight loss surgery. Current literature is limited with regard to bariatric surgery in patients after solid organ transplant. Transplant recipients carry a higher morbidity and mortality compared to the remainder of the population. Our objective is to analyze the potential risk factors and postoperative complications in weight loss surgery patients after organ transplantation, comparing sleeve gastrectomy vs gastric bypass.
MBSAQIP patient use files for 2017 were queried for all patients who had previous solid organ transplant. Outcome variables and patient characteristics were compared between sleeve gastrectomy and gastric bypass using Student’s t-test for continuous variables and Chi-square test and Fisher’s exact test for categorical variables. Significance was considered at p<0.05.
383 transplant recipients who subsequently underwent a gastric bypass or sleeve gastrectomy were identified. Significantly different preoperative characteristics between sleeve gastrectomy and gastric bypass were sex, renal insufficiency, creatinine and chronic steroid/immunosuppressant use (Table 1). 30 day readmission rate was the only significant postoperative complication different between sleeve gastrectomy (7%) and gastric bypass (17%) (Table 1).
Our findings, from the largest series to date, conclude that both gastric bypass and sleeve gastrectomy are safe, in the short-term, in patients after solid organ transplant. There is a low risk of morbidity and mortality in this higher risk population. Long-term complications in patients on chronic immunosuppressive agents are not evaluated in this study.