Bariatric surgery for obese live kidney donors: an analysis of risks and benefits

Background: Obesity can be a barrier to live donor selection and there are reports of obese live kidney donors (OLKDs) undergoing bariatric surgery prior to donation. While this practice has potential promise, the risks associated with it are unclear. Thus, our aim was to evaluate the advantages and disadvantages of this practice. Design: Risks and benefits were ascertained from the literature. Analysis of costs and benefits was performed to provide objective data for each scenario. Results: Live kidney donation is associated with superior outcomes compared to deceased donation. However, live donors are at risk of complications that could be exacerbated by obesity. Higher donor body mass index (BMI) has been associated with inferior recipient outcomes. Bariatric surgery (BS) results in decreased mortality and can induce sustained weight loss. Our cost-benefit analysis revealed a benefit-to-cost ratio of 3.64 for BS prior to live donation by OLKDs. We found ratios of 3.19 and 0.97 for live donation with an obese donor and a deceased donor, respectively. Conclusions: Our results suggest that BS for an OLKD has the potential to increase the number of live donors and improve outcomes. However, more data is required; thus we recommend a registry of patients who have undergone both procedures. or not the benefits outweigh the risks. National databases such as the United Network for Organ Sharing and the National Surgical Quality Improvement Program do not capture patients who have undergone BS with subsequent live donation. Given that the frequency of this scenario will likely rise with the increasing rate of obesity and a greater need for live donors, we sought to clarify the risk factors associated with it in order to maximize live donor safety and better inform the transplant community. Furthermore, we aimed to determine the costs and benefits such a strategy would have compared to donation from an obese live donor, and a deceased donor.