*Purpose: The purpose of this study is to demonstrate that simultaneous robotic assisted kidney transplant and robotic assisted sleeve gastrectomy results in fewer surgical complications and better medical outcomes for obese patients with end stage renal disease compared to kidney transplant alone.

*Methods: This is a single center, open label, prospective, randomized trial comparing robotic kidney transplant in combination with sleeve gastrectomy or robotic kidney transplant alone. Kidney transplant recipients with a BMI 40 kg/m2 or greater were eligible for inclusion.

*Results: This is a analysis of the first 22 subjects randomized and transplanted. Not all patients have reached 1 year post-transplant. The change in weight and BMI are presented in table 1. We did not encounter significant technical complications in either group.GFR at 1 year is similar between the 2 groups.

*Conclusions: Simultaneous kidney transplant and sleeve gastrectomy was safe and resulted in significant weight loss over 12 months post-transplant.

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