**3.4 Renal transplant patients**

Morbid obesity is a barrier to kidney transplantation due to inferior outcomes, higher rates of new-onset diabetes after transplantation, delayed graft function, and graft failure [66]. LSG improves renal transplant candidacy and post transplant outcomes in morbidly obese patients [67, 68]. Kidney recipients who underwent LSG were compared with similar BMI recipients who did not undergo LSG [67]. In this study, the BMI decreased from 41.5 to 32.3 kg/m2 , with no complications, readmissions, or mortality following LSG [67]. After transplantation, one patient experienced delayed graft function and no other patients had new-onset diabetes [67]. Moreover, allograft survival and patient survival at 1-year post transplantation were 100% [67]. Compared with non-LSG patients, post-LSG recipients had significantly lower delayed graft function rates and renal dysfunction-related readmissions [67]. Longer duration studies showed that LSG in patients with obesity and end-stage kidney disease was associated with lower all-cause mortality at 5 years compared with usual care (cumulative incidence 25.6% vs 39.8%; hazard ratio 0.69, 95% CI, 0.60–0.78), which is likely driven by the lower mortality from cardiovascular disease [68]. Moreover, LSG was associated with an increased rate of kidney transplant at 5 years (cumulative incidence 33.0% vs 20.4%; hazard ratio 1.82; 95% CI, 1.58–2.09) [68].
