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Life sciences · Review
Gastrointestinal Disorders · September 21, 2026
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Review.
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Background/Objectives: Obesity can delay kidney-transplant listing, and metabolic and bariatric surgery (MBS) may help address this barrier, but its role, timing, and procedure choice are not established for every candidate. We evaluated transplant-access outcomes, failed pathways, bariatric safety, procedure-specific considerations, and evidence relevant to pretransplant referral. Methods: PubMed/MEDLINE, Embase, and Google Scholar were searched through 6 August 2026. The review and protocol were prospectively registered in PROSPERO. Reports were mapped to access/pathway, bariatric-safety, post-transplant, and procedure/timing/pharmacokinetic/enteric-oxalate domains. Cumulative transplantation proportions were synthesized as an exploratory outcome using a restricted maximum likelihood random-effects model with Hartung–Knapp confidence intervals. Results: Forty-seven reports from 30 source clusters were included. Across 10 independent bridge cohorts (180/531 transplants), the pooled proportion over heterogeneous study-specific follow-up was 39.6% (95% CI, 28.2–52.3%; I2 = 77.4%), with a 95% prediction interval of 12.9–74.4%. This pooled estimate was descriptive and non-comparative. Adjusted observational estimates favored MBS for waitlisting, active listing, or kidney transplantation but were not pooled because their estimands and pathway structures differed. The two randomized trials had some concerns and high risk of bias, respectively, and all 23 nonrandomized comparative results were at serious or critical risk of bias. No validated treatment-effect modifier or referral prediction model was identified. Conclusions: MBS may facilitate transplant access when obesity is a principal reversible barrier. However, very-low-certainty evidence establishes neither a causal effect of MBS on transplant access nor referral criteria, an individual transplantation probability, optimal timing, or superiority of sleeve gastrectomy over gastric bypass. Referral and procedure choice should remain individualized and multidisciplinary.