30-Day Outcomes of Simultaneous Sleeve Gastrectomy and Kidney Transplantation: An Analysis from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Database

BACKGROUND: Obesity limits access to kidney transplantation (KT) and worsens outcomes in patients with end-stage renal disease (ESRD). Sleeve gastrectomy (SG) is increasingly used to facilitate transplant eligibility; however, the safety of simultaneous SG and KT (SG + KT) remains poorly defined at a multi-institutional level. This study evaluates 30-day perioperative outcomes of SG + KT using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. METHODS: A retrospective analysis of the MBSAQIP database (2020-2023) was performed. Adult patients undergoing SG were identified with simultaneous KT and captured using CPT codes. Demographics, comorbidities, operative characteristics, and 30-day outcomes were compared between SG-only and SG + KT cohorts. Multivariable logistic regression was used to identify independent predictors of serious complications and 30-day mortality. RESULTS: Among 582,860 patients undergoing SG, 22 (0.004%) underwent simultaneous KT. SG + KT patients were older, predominantly male, and had significantly higher rates of diabetes, hypertension, renal insufficiency, and dialysis dependence (all p < 0.001), with similar body mass index compared to SG alone. SG + KT was associated with longer operative time, increased length of stay, and higher rates of bleeding, readmission within 30-days and serious complications (all p ≤ 0.001). Thirty-day mortality was significantly higher following SG + KT (9.1% vs. 0.1%, p < 0.001). On multivariable analysis, simultaneous KT was the strongest independent predictor of serious complications (OR 7.97; 95% CI 2.27-27.93; p = 0.001) and mortality (OR 33.99; 95% CI 3.99-289.03; p = 0.001). CONCLUSION: Simultaneous sleeve gastrectomy and kidney transplantation is exceedingly rare and associated with markedly increased 30-day morbidity and mortality compared with sleeve gastrectomy alone, highlighting the need for careful patient selection and multidisciplinary risk assessment.