Impact of Chronic Immunosuppression on Short-, Mid-, and Long-Term Bariatric Surgery Outcomes

• Published in: Obesity surgery Vol. 33; no. 1; pp. 240 - 246
• Main Authors: Maroun, Justin, Vahibe, Ahmet, Shah, Meera, Mundi, Manpreet S., Acosta, Andres, McKenzie, Travis J., Kellogg, Todd A., Ghanem, Omar M.
• Format: Journal Article
• Language: English
• Published: New York Springer US 2023; Springer Nature B.V
• Subjects: Bariatric Surgery; Gastrectomy - adverse effects; Gastric Bypass - adverse effects; Gastrointestinal surgery; Humans; Immunosuppression Therapy; Medicine; Medicine & Public Health; Obesity, Morbid - surgery; Original Contributions; Patients; Retrospective Studies; Surgery; Surgical outcomes; Treatment Outcome; Surgical outcomes; Surgical complications; Immunosuppression; Immunocompromised patients; Bariatric surgery
• ISSN: 0960-8923; 1708-0428
• DOI: 10.1007/s11695-022-06372-7

Introduction
Bariatric surgical outcomes depend heavily on proper healing of gastrointestinal anatomy, metabolic alterations, and patient lifestyle modifications which are all negatively impacted by immunosuppression and underlying inflammatory diseases. There is a lack of literature exploring how patients with diseases requiring immunosuppression respond to bariatric surgical intervention in the long term.
Methods
A retrospective analysis of chronically immunosuppressed patients who underwent primary bariatric surgeries at Mayo Clinic was conducted (2008–2020). Data collected included patient demographics, BMI, underlying disease, and immunosuppression regimen and complications at 3, 6, 12, 24, and 60 months.
Results
We identified a total of 89 (RYGB = 49, SG = 34, BPD/DS = 6) patients on chronic immunosuppression who underwent bariatric surgery at our center. RYGB (
N
 = 49), 38.2% had a SG (
N
 = 34) and 6.7% had a BPD/DS (
N
 = 6). Rheumatoid arthritis and renal transplantation were the most underlying condition at 20.22% each (
N
 = 18). There were a total of 2 (2.25%) intraoperative complications. In the immediate post-operative period, there were 15 (16.5%) minor complications. In follow-up, 6.1% of RYGB patients experienced marginal ulcerations, while no gastrointestinal leaks occurred. The mean pre-surgical BMI was 48.29 kg/m
2
(SD = 18.41). Percent total weight loss (%TWL) and BMI reduction were 30.89% and 14.83 kg/m
2
(SD = 9.07) at 12 months and 29.48% and 14.43 kg/m
2
(SD = 13.46) at 60 months, respectively. The mean follow-up time was 30.49 months.
Conclusions
Bariatric surgery remains safe and effective therapy for chronically immunosuppressed patients with excellent long-term outcomes for patients with moderate to severe obesity.
Graphical Abstract