# Bariatric Surgery and Lung Transplant Outcomes: Case Series and Insights from a Propensity-Matched Analysis at a High-Volume Transplant Center

## TL;DR

This study finds that prior bariatric surgery does not worsen lung transplant outcomes, including survival and graft function.

## Contribution

The study provides new evidence that bariatric surgery does not compromise lung transplant outcomes in patients with advanced respiratory disease.

## Key findings

- Bariatric surgery recipients had similar survival rates and graft outcomes compared to matched controls.
- Hospital and ICU lengths of stay were comparable between bariatric and control groups.
- Rates of complications like primary graft dysfunction and rejection were similar in both groups.

## Abstract

An increasing number of patients with a history of bariatric surgery and advanced respiratory disease are presenting for lung transplantation (LTx). We aimed to describe and compare LTx outcomes between recipients with prior bariatric surgery and a matched control group at a high-volume lung transplant center.

After IRB approval, we identified bilateral LTx recipients with a pre-LTx history of bariatric surgery (Roux-en-Y gastric bypass [RYGB], sleeve gastrectomy [SG], or laparoscopic adjustable gastric band [LAGB]). The institutional experience is reported as a case series. Furthermore, perioperative and mid-term transplant outcomes such primary graft dysfunction (PGD), antibody-mediated rejection (AMR), acute cellular rejection (ACR), chronic lung allograft dysfunction (CLAD)-free survival, and overall survival (OS) were compared to a 1-to-2 propensity score-matched control group.

Nine patients (median age: 65 years; 77.8% female) with a history of bariatric surgery (RYGB = 4, SG = 4, LAGB = 1) a median of 76 months before LTx were included. The median hospital length of stay (LOS) and ICU-LOS were similar to the control group (n = 18). Moreover, 1-, 2-, and 3-year OS in bariatric and control groups were similar (88.9%, 88.9%, and 66.7% vs. 100%, 86.7%, and 78%, respectively; p = 0.27). CLAD-free survival and rates of PGD, AMR, and ACR were also similar.

Prior bariatric surgery may not affect overall or CLAD-free survival after bilateral LTx. Bariatric surgery for obesity treatment in patients with advanced lung diseases may improve their LTx candidacy without compromising early and mid-term transplant outcomes.

The online version contains supplementary material available at 10.1007/s11695-025-07932-3.