{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T20:56:38Z","timestamp":1790110598968,"version":"4.0.1"},"reference-count":31,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Obesity is extremely common among patients with end stage renal disease (ESRD) due to shared metabolic risk factors. Renal transplantation is the gold standard treatment for ESRD, however obesity is a major barrier due to increased anaesthetic risks, surgical complications and poorer graft outcomes. The aim of this study was to assess ESRD patients referred for metabolic bariatric surgery (MBS) in Scotland. Methods: Data from all adult patients with ESRD who were referred for MBS in Scotland from January 2014 to August 2025 were obtained retrospectively. Categorical data are presented as number and percentage; non-parametric continuous data are presented as median and inter-quartile range. A focused review of comparable published cohorts was performed for context. Results: A total of 9 patients with ESRD were referred for MBS over the study period; of these, 5 patients went on to have MBS. Of the patients who underwent MBS, the median age at referral was 47 years, 3 of 5 were female and the median starting weight and body mass index (BMI) were 131 kg and 49 kg\/m2 respectively. Four patients underwent laparoscopic sleeve gastrectomy, and 1 patient underwent one-anastomosis gastric bypass. The median length of hospital stay was 2 days. The median total percentage weight loss was 33.5% (range 27.7% to 48.1%). Four of the five patients were able to be activated on the transplant waiting list after successfully achieving their target weight after a median of 8.4 months. Of the 4 listed patients, 3 were transplanted with no post-operative complications, and 1 remains active on the waiting list. Across seven comparable cohorts (19 to 198 operated patients), all single- or two-centre, ours had the only national coverage. Listing and transplantation outcomes (4 of 5 listed, 3 of 5 transplanted) were broadly consistent with the range reported in these cohorts, although the small sample precludes formal comparison. Conclusions: In this small case series and review, MBS appeared safe and feasible in a highly selected group of patients with obesity and ESRD. MBS facilitates access to renal transplant but is under-utilised in Scotland. We plan to formalise a national treatment pathway to streamline access to bariatric services for patients with ESRD and enable more patients to undergo renal transplantation.<\/jats:p>","DOI":"10.3390\/jcm15145500","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T05:32:01Z","timestamp":1784007121000},"page":"5500","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Metabolic Bariatric Surgery to Facilitate Access to Renal Transplantation for Patients with Obesity and End- Stage Renal Disease: A National Case Series and Focused Review"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-6357-0053","authenticated-orcid":false,"given":"Sebastian","family":"Mitchell","sequence":"first","affiliation":[{"name":"Upper Gastrointestinal and Bariatric Surgery, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9377-937X","authenticated-orcid":false,"given":"Diana A.","family":"Wu","sequence":"additional","affiliation":[{"name":"Edinburgh Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Cheah","sequence":"additional","affiliation":[{"name":"Upper Gastrointestinal and Bariatric Surgery, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Mekhail","sequence":"additional","affiliation":[{"name":"Upper Gastrointestinal and Bariatric Surgery, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shayanthan","family":"Nanthakumaran","sequence":"additional","affiliation":[{"name":"Upper Gastrointestinal and Bariatric Surgery, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7672-9696","authenticated-orcid":false,"given":"Emma","family":"MacVicar","sequence":"additional","affiliation":[{"name":"Upper Gastrointestinal and Bariatric Surgery, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Gibson","sequence":"additional","affiliation":[{"name":"Upper Gastrointestinal and Bariatric Surgery, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Ghita","sequence":"additional","affiliation":[{"name":"Glasgow Transplant Unit, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK"},{"name":"Upper Gastrointestinal and Bariatric Surgery, University Hospital Hairmyres, Glasgow G75 8RG, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Joyce","sequence":"additional","affiliation":[{"name":"Upper Gastrointestinal and Bariatric Surgery, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gillian","family":"Drummond","sequence":"additional","affiliation":[{"name":"Upper Gastrointestinal and Bariatric Surgery, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter J.","family":"Lamb","sequence":"additional","affiliation":[{"name":"Upper Gastrointestinal and Bariatric Surgery, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3491-4452","authenticated-orcid":false,"given":"Rachel A. B.","family":"Thomas","sequence":"additional","affiliation":[{"name":"Edinburgh Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chetan","family":"Parmar","sequence":"additional","affiliation":[{"name":"Upper Gastrointestinal and Bariatric Surgery, Whittington Hospital, London N19 5NF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria","family":"Banwell","sequence":"additional","affiliation":[{"name":"Edinburgh Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew G.","family":"Robertson","sequence":"additional","affiliation":[{"name":"Upper Gastrointestinal and Bariatric Surgery, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,14]]},"reference":[{"key":"ref_1","unstructured":"Wu, D.A. (2020). Chapter 3: Variations in the Comorbidity Burden of Patients Accepted for Kidney Transplantation Across the UK. From: Survival Modelling for Patients with End Stage Renal Failure: Implications for Access to Renal Transplantation in the UK. [Ph.D Thesis, University of Edinburgh]."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1725","DOI":"10.1056\/NEJM199912023412303","article-title":"Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant","volume":"341","author":"Wolfe","year":"1999","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/S0272-6386(00)70009-6","article-title":"Differences in quality of life across renal replacement therapies: A meta-analytic comparison","volume":"35","author":"Cameron","year":"2000","journal-title":"Am. J. Kidney Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1016\/j.bjae.2020.07.003","article-title":"Anaesthesia for the obese patient","volume":"20","author":"Bouch","year":"2020","journal-title":"BJA Educ."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1016\/j.euf.2023.11.003","article-title":"Effect of recipient body mass index on kidney transplantation outcomes: A systematic review and meta-analysis by the transplant committee from the french association of urology","volume":"10","author":"Prudhomme","year":"2024","journal-title":"Eur. Urol. Focus"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1111\/j.1523-1755.2004.00385.x","article-title":"Body mass index, dialysis modality, and survival: Analysis of the United States Renal Data System Dialysis Morbidity and Mortality Wave II Study","volume":"65","author":"Abbott","year":"2004","journal-title":"Kidney Int."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1007\/s40620-019-00654-7","article-title":"UK renal transplant outcomes in low and high BMI recipients: The need for a national policy","volume":"33","author":"Kostakis","year":"2020","journal-title":"J. Nephrol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1016\/j.eprac.2024.07.008","article-title":"The use of semaglutide in patients with renal failure-A retrospective cohort study","volume":"30","author":"Long","year":"2024","journal-title":"Endocr. Pract."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"100777","DOI":"10.1016\/j.trre.2023.100777","article-title":"Bariatric surgery improves access to renal transplantation and is safe in renal failure as well as after transplantation: A systematic review and meta-analysis","volume":"37","author":"Fernando","year":"2023","journal-title":"Transplant. Rev."},{"key":"ref_10","unstructured":"Public Health Scotland (2025, October 17). Scottish Renal Registry\u2014Annual Report 2025 [Internet]. Available online: https:\/\/publichealthscotland.scot\/publications\/scottish-renal-registry\/scottish-renal-registry-annual-report-2025\/."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"i1","DOI":"10.1093\/ndt\/gfab310","article-title":"Management of obesity in kidney transplant candidates and recipients: A clinical practice guideline by the DESCARTES Working Group of ERA","volume":"37","author":"Oniscu","year":"2021","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1097\/SLE.0000000000001313","article-title":"Long-term weight loss and comorbidity resolution of laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass and the impact of preoperative weight loss on overall outcome","volume":"34","author":"Lucocq","year":"2024","journal-title":"Surg. Laparosc. Endosc. Percutaneous Tech."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1111\/ajt.15650","article-title":"Long-term outcomes in patients with obesity and renal disease after sleeve gastrectomy","volume":"20","author":"Kassam","year":"2020","journal-title":"Am. J. Transplant."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1016\/j.mayocp.2024.01.017","article-title":"Weight loss surgery increases kidney transplant rates in patients with renal failure and obesity","volume":"99","author":"Kukla","year":"2024","journal-title":"Mayo Clin. Proc."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1007\/s11695-023-06985-6","article-title":"Bariatric surgery as a bridge to facilitate renal transplantation in patients with end-stage renal disease","volume":"34","author":"Bosch","year":"2024","journal-title":"Obes. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"3436","DOI":"10.1007\/s11695-021-05435-5","article-title":"Effectiveness of bariatric surgery in increasing kidney transplant eligibility in patients with kidney failure requiring dialysis","volume":"31","author":"Soliman","year":"2021","journal-title":"Obes. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"964","DOI":"10.1111\/tri.13855","article-title":"Successful surgical weight loss with laparoscopic sleeve gastrectomy for morbid obesity prior to kidney transplantation","volume":"34","author":"Hajjar","year":"2021","journal-title":"Transpl. Int."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2373","DOI":"10.1007\/s11695-019-03925-1","article-title":"Bariatric surgery is efficacious and improves access to transplantation for morbidly obese renal transplant candidates","volume":"29","author":"Yemini","year":"2019","journal-title":"Obes. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e13232","DOI":"10.1111\/ctr.13232","article-title":"Roux-en-Y gastric bypass is an effective bridge to kidney transplantation: Results from a single center","volume":"32","author":"Thomas","year":"2018","journal-title":"Clin. Transplant."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"c209","DOI":"10.1159\/000328070","article-title":"Renal Association Clinical Practice Guideline on the assessment of the potential kidney transplant recipient","volume":"118","author":"Dudley","year":"2011","journal-title":"Nephron. Clin. Pract."},{"key":"ref_21","unstructured":"NICE (2025, October 11). Overweight and Obesity Management [Internet]. Available online: https:\/\/www.nice.org.uk\/guidance\/ng246."},{"key":"ref_22","unstructured":"Department of Health (2025, October 11). Best Practice Guidance for Weight Management Services [Internet], Available online: https:\/\/www.gov.uk\/government\/publications\/best-practice-guidance-for-weight-management-services."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e325","DOI":"10.1093\/pubmed\/fdv132","article-title":"Variations in weight management services in Scotland: A national survey of weight management provision","volume":"38","author":"Read","year":"2016","journal-title":"J. Public Health"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1093\/bjs\/znab245","article-title":"Perioperative mortality in bariatric surgery: Meta-analysis","volume":"108","author":"Robertson","year":"2021","journal-title":"Br. J. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1001\/jamasurg.2019.2824","article-title":"Risks of bariatric surgery among patients with end-stage renal disease","volume":"154","author":"Montgomery","year":"2019","journal-title":"JAMA Surg."},{"key":"ref_26","unstructured":"Public Health Scotland (2025, October 18). Referrals to NHS Board Commissioned Weight Management Services for Children and Adults\u20141 October 2019 to 30 September 2022. [Internet]. Available online: https:\/\/publichealthscotland.scot\/publications\/referrals-to-nhs-board-commissioned-weight-management-services\/referrals-to-nhs-board-commissioned-weight-management-services-for-children-and-adults-1-october-2019-to-30-september-2022\/."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"S417","DOI":"10.1016\/j.ajt.2025.07.958","article-title":"Bariatric surgery vs. GLP-1 receptor agonists: Mortality risk and access to kidney transplantation","volume":"25","author":"Chen","year":"2025","journal-title":"Am. J. Transplant."},{"key":"ref_28","unstructured":"Kidney Research UK (2026, March 26). Chronic Kidney Disease: An Action Plan for Scotland [Internet]. Available online: https:\/\/www.kidneyresearchuk.org\/wp-content\/uploads\/2024\/11\/KRUK-Chronic-Kidney-Disease-Scottish-Action-Plan.pdf."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e084356","DOI":"10.1136\/bmjopen-2024-084356","article-title":"Assessing economic investment required to scale up bariatric surgery capacity in England: A health economic modelling analysis","volume":"14","author":"Pournaras","year":"2024","journal-title":"BMJ Open"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"362","DOI":"10.3747\/pdi.2017.00018","article-title":"Length of time on peritoneal dialysis and encapsulating peritoneal sclerosis\u2014Position paper for ISPD: 2017 update","volume":"37","author":"Brown","year":"2017","journal-title":"Perit. Dial. Int."},{"key":"ref_31","first-page":"e1230","article-title":"PRISMA2020: An R package and Shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and Open Synthesis","volume":"18","author":"Haddaway","year":"2022","journal-title":"Campbell Syst. Rev."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/14\/5500\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T05:35:07Z","timestamp":1784007307000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/14\/5500"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,14]]},"references-count":31,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["jcm15145500"],"URL":"https:\/\/doi.org\/10.3390\/jcm15145500","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,14]]}}}