*Purpose: Bariatric surgery benefits obese patients by promoting weight loss, improving quality of life, and reducing morbidity and mortality rates. There is concern, however, that for obese patients who need solid organ transplants, undergoing bariatric surgery may affect therapeutic levels of anti-rejection drugs and rejection rates of organs. The purpose of this study is to look at the clinical outcomes of liver and kidney transplant patients who have either previously or concurrently undergone bariatric surgery.

*Methods: We looked at the medical records of 10 transplant patients (8 liver, 2 liver-kidney) who had either previously or concurrently gastric bypasses or gastric sleeve operations within the last 20 years prior to transplant. Records were analyzed for dosages and trough levels of all anti-rejection drugs used, adverse events, and nutritional status.

*Results: Data analysis was performed using Stata software. Eight patients received bariatric surgery prior to transplant; 2 had concurrent bariatric and transplant surgeries. Results showed no differences in rates of acute rejection from liver transplant patients who had previously not undergone bariatric surgery. There was no difficulty in maintaining therapeutic tacrolimus trough levels through post-operative days 30 (mean = 6.45 ng/ml; standard error = 0.51 ng/ml), 60 (6.78; 0.55), 90 (7.45; 0.27), and 180 (7.26; 0.52), and years 1 (7.40; 0.98) and 2 (7.46; 0.94). Therapeutic cyclosporine levels were well-maintained (post-operative days 30 [87.87 ng/ml; 31.44 ng/ml]; 60 [110.65; 19.68]; 90 [109.71; 26.12]; 180 [106.75; 20.05]; 1 year [110.23; 20.59]; 2 years [113.58; 18.89]). One patient who received concurrent liver-kidney transplant and gastric sleeve surgery had kidney rejection on post-operative day 180 (cyclosporine level = 108 ng/ml). After experiencing side effects including seizures and renal toxicity, 4 patients discontinued tacrolimus and started taking cyclosporine on post-operative days 3, 10, 13, 25. Nutrition was adequately maintained post-transplant in 8 patients.

*Conclusions: Use of bariatric surgery is not shown to have a detriment to clinical outcomes in obese liver and kidney transplant patients. Considering the benefits to quality of life and morbidity and mortality outcomes, it is useful to perform bariatric surgery on obese patients either before or during liver transplant. Further study in concurrent liver-kidney transplants and gastric sleeve surgery needs to be done to look at rejection rates and other long-term outcomes.

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