Effect of Sleeve Gastrectomy on Frailty and Physical Function in Kidney Transplant Candidates

Background: Kidney transplant (KT) candidates with obesity are often advised to lose weight to qualify for transplantation. While sleeve gastrectomy (SG) is a promising strategy, the resulting weight loss leads to muscle loss that can potentially increase frailty. We aimed to assess the effect of SG on frailty and physical performance in KT candidates. Methods: We retrospectively studied KT candidates with obesity undergoing SG for the purpose of KT listing vs. nonsurgical weight loss (non-SG) cohort. All patients underwent longitudinal weight and frailty assessment by Short Physical Performance Battery (SPPB) and Total Frailty Score (TFS). Muscle mass was additionally assessed by dual-energy X-ray absorptiometry approximately 2 months post SG. All patients received nutritional support and exercise counseling. . Results: 13 patients underwent SG and 9 were in non-SG group (Table 1). BMI decreased from 40.5±3.3 to 33.0±3.8 and 32.2±3.9 at 6 and 12 months post-SG (p=<.001), with total weight loss of 18.5% and 20.7%, respectively. The non-SG cohort had no change at 6 and 12 months (p=.06 each). Baseline median (IQR) SPPB was higher in the SG group (p=.02) and remained stable at 12.0 (11.0–12.0) (p=.50), while the non-SG group changed from 10.0 (8.0–11.0) to 11.0 (11.0–12.0) at 1-2 years (p=.03). There was no between-group difference at follow-up (p=.69). TFS was unchanged at 1-2 years in both groups (p=.46 SG; p=1.00 non-SG). Post-SG functional decline occurred in two cases, one due to diabetes and other to post-surgical complications (Figure 1). At 7.0±2.3 months follow-up, 1/9 SG patients (11%) had sarcopenia, and 8/9 (89%) had normal body composition. Conclusion: SG preserves functional status and does not cause sarcopenia in most KT candidates in a structured program with rigorous follow-up.