Background: The long-term follow-up studies investigating the risk of anemia and iron deficiency following bariatric procedures are scarce. This study aimed to determine the influence of body weight reduction and type of bariatric surgery on iron metabolism parameters. Methods: We included 138 consecutive patients who underwent bariatric surgery (120 underwent sleeve gastrectomy and 18 underwent other types of bariatric surgery) between 2010 and 2016. At baseline and at follow-up (median observation: 10 years), examination weight and height were measured, and blood samples for iron metabolism parameters were taken. Results: Red blood cells (4.75 [4.59–4.96] 10⁶/μL vs. 4.51 [4.25–4.83] 10⁶/μL, p < 0.0001), hemoglobin (14.0 [13.3–14.7] g/dL vs. 13.0 [12.1–14.3] g/dL, p < 0.0001), and folic acid (7.4 [5.9–10.4] ng/ml vs. 6.0 [4.5–9.1] ng/mL, p = 0.01) were significantly lower, while anemia prevalence (6.52% vs. 28.99%, p < 0.0001) was significantly higher at the follow-up examination compared to the baseline values. In contrast, iron concentration (86.5 [68.0–109.0] µg/dL vs. 86.5 [55.0–110.0] µg/dL, p = 0.42) and TIBC values (351 [326–391] µg/dL vs. 345 [5311–387] µg/dL, p = 0.08) did not change significantly. The multivariable regression analyses showed that the only factors independently related to the hemoglobin concentration change were initial hemoglobin concentration, age, and bariatric procedures other than sleeve gastrectomy. Similarly, in the multivariable logistic analysis, the only variables independently related to the risk of anemia were age (adjusted odds ratio 0.93 [95% confidence intervals 0.89–0.97]), initial hemoglobin concentration (0.69 [0.49–0.97]), and procedures other than sleeve gastrectomy bariatric procedures (6.12 [1.86–20.15]). Conclusions: Age, initial hemoglobin concentration, and type of bariatric procedure but not sex, baseline iron serum level, or weight change are related to the risk of anemia in the long-term follow-up following bariatric surgery.

BACKGROUND Horseshoe kidney is a rare congenital anomaly, occurring in approximately 1 in 400 to 1 in 1800 individuals. When considering transplantation, horseshoe kidneys present unique challenges due to vascular and urinary tract anomalies. They can be transplanted either as a whole, en bloc unit or as 2 separate, split fragments. The complexities in vascular and urinary reconstruction require careful consideration to ensure successful transplantation. CASE REPORT We present a case involving the transplantation of a horseshoe kidney from a deceased 36-year-old male donor with confirmed brain death due to intracerebral bleeding. The kidney had a complex vascular arrangement, with 7 arteries, 2 veins, and 2 ureters. A surgical division and vascular reconstruction were performed. The kidney fragments were successfully transplanted into 64- and 65-year-old male recipients. Both grafts exhibited excellent reperfusion, and at 2-month follow-up, both patients demonstrated satisfactory graft function, without dialysis or acute rejection episodes. CONCLUSIONS In light of the ongoing shortage of kidney grafts, horseshoe kidneys represent a valuable yet challenging option for transplantation. While vascular and urinary tract anomalies can complicate their use, this case illustrates that, with meticulous surgical technique, horseshoe kidney transplantation can be both viable and safe. Nevertheless, the absence of standardized guidelines for splitting techniques and pre-procurement anatomical assessment underscores the need for further research and consensus in this area.