Laparoscopic sleeve gastrectomy in a patient with type 1 diabetes and kidney transplant: A case report.

Introduction: Obesity in patients with type 1 diabetes mellitus (T1DM) and kidney disease presents unique challenges, particularly after transplantation, where weight gain can compromise graft function and metabolic control. Bariatric surgery has emerged as a therapeutic option in transplant recipients with obesity, though its role in T1DM remains less explored. Main concerns and clinical finings: We report the case of a 45-year-old man with longstanding T1DM complicated by hypertension, diabetic retinopathy, and end-stage renal disease, who underwent a deceased-donor kidney transplant at age 40. Post-transplant, he developed type III obesity (BMI 44.5 kg/m2), poor glycemic control (HbA1c 9.8 %), and severe hepatic steatosis despite intensive medical therapy. Intervention: Laparoscopic sleeve gastrectomy was performed without intraoperative complications (operative time 70 minutes, specimen weight 100 g, minimal blood loss). The postoperative course was notable only for a transient ileus requiring two days of hospitalization. At follow-up, the patient demonstrated significant weight loss, resolution of albuminuria, improved glycemic stability with marked reduction in insulin requirements, and improvement of hepatic steatosis. Importantly, immunosuppressant drug levels consistently remained within therapeutic range throughout follow-up. Conclusion: This case highlights the safety and efficacy of sleeve gastrectomy in a kidney transplant recipient with longstanding T1DM, resulting in significant metabolic, renal, and hepatic improvements without compromising graft function or immunosuppressive therapy. To our knowledge, this is the first reported case of sleeve gastrectomy in a patient with T1DM following kidney transplantation, underscoring its feasibility and the need for further research in this complex population.