*Purpose: Bariatric surgery is one of the most common operations. Laparoscopic sleeve gastrectomy (LSG) has been reported to prepare candidates for listing. However, weight gain is also common after kidney transplantation (KT) with multiple factors implicated. It is currently unclear how prior LSG affects weight after KT.

*Methods: A retrospective review was performed to evaluate the evolution of body mass index (BMI) following KT in LSG patients. The cohort represents the combined experience, between 2013 and 2017, at two university-affiliated hospital centres and was approved by the respective research ethics committees.

*Results: Nineteen LSG+ patients were identified. The median age was 49 years with slightly more females (52.6%). The most common co-morbid disease was hypertension (93%), followed by dyslipidemia (61%) and insulin-dependent diabetes (46%). The median time elapsed between the LSG and KT was just over a year (376 days) during which the median change in body mass index (dBMI) was -9.7 kg/m². All recipients had successful transplantation with a 32% DGF rate. The immediate post-transplantation complications included deep surgical site collections (21%), urinary tract infection (21%) and dehydration (11%). The 1-year acute rejection rate was 16% (2 BPAR and 1 clinical). LSG+ recipients had a median dBMI of -0.8 kg/m² at 1-year. Two patients (11%) had weight gain (dBMI% > 10%), of which only one would be considered recurrent morbid obesity. In comparison, the overall experience of case control (non-bariatric) kidney transplant recipients over the same period had a rate of significant increase in BMI (>10%) gain of 18.3 % and the median dBMI of +0.59 kg/m². There was a statistically significant difference in the dBMI favouring weight loss in the LSG+ sub-group (p = 0.00324, two-tailed t-test).

*Conclusions: Although this experience of KT in LSG patients is the largest reported to date, the sample size is relatively small with short follow-up. This is the first evidence that surgical weight loss of LSG is durable, at least until the first year after kidney transplantation. The next stage will be to evaluate the long-term weight evolution in a larger cohort and its impact on graft and patient survival, in particular cardiovascular disease.

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