Metabolic and Bariatric Surgery Before Kidney Transplantation: Referral Considerations, Access Outcomes, Procedure Choice, Safety, and Evidence Gaps—A Systematic Review and Exploratory Meta-Analysis

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.