Effect of immunosuppressive agents on bariatric surgery: a systematic review
In brief
Immunosuppressed bariatric patients face more complications but similar weight loss
Across 33 studies, immunosuppressive therapy was associated with more postoperative complications, while weight loss and metabolic improvements remained in line with established results. Sleeve gastrectomy was considered safe, but the evidence spans varied conditions and drugs; larger prospective studies are needed to guide procedure choice and clarify risks from individual agents.
- Journal
- Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery (Q1)
- Published
- 23 September 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Si Louise Sun, Kayna Fichadia, Hyerim Suh, Ernest Cheng, Yan Tan Shan, Amer Matar, et al.
- PMID
- 42995060
- DOI
- 10.1016/j.soard.2026.08.031
Why clinicians should know about it
- Picked for Bariatric and Metabolic Surgery (top studies of the week, 8 November 2026): Bariatric procedure safety in immunosuppressed patients
Abstract
Bariatric surgery is a well-established treatment for obesity and its associated co-morbidities. The impact of immunosuppressive therapy on patients undergoing bariatric surgery remains poorly understood although it has been associated with higher infection rates, poor wound healing, and anastomotic leakage. Evidence on the effect of immunosuppressive agents on bariatric surgery is warranted to optimize patient care and surgical success. We aimed to evaluate the impact of immunosuppressive agents on weight loss outcomes and complication rates after common bariatric procedures. A systematic review was conducted across PubMed, Google Scholar, Medline, and Embase since December 2013 using keywords related to immunosuppressive agents and bariatric surgery to select primary, peer-reviewed studies for analysis. Thirty-three studies met inclusion criteria. Immunosuppressive agents analyzed included corticosteroids, disease-modifying antirheumatic drugs, biologic agents, and calcineurin inhibitors across various bariatric procedures. Immunosuppressive conditions consisted of inflammatory bowel disease in 3 studies, solid organ transplant in 21 studies, rheumatoid arthritis in 3 studies, systemic lupus erythematosum in 1 study, and 6 studies with an unspecified immunosuppressive agent, most commonly corticosteroids. Immunosuppressive agents were associated with higher postoperative complication rates after bariatric surgery; however, weight loss outcomes and metabolic improvements remained consistent with established literature. Sleeve gastrectomy (SG) is safe in immunosuppressed patients; however, consideration of individual patient profile is important in procedural planning and selection. Large-scale prospective research is required to substantiate the evidence for procedural selection and the effects of individual immunosuppressive agents.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.