Patients with obesity are the largest and fastest-growing demographic among individuals with renal failure in the United States. Transplant centers often reject patients with high body mass index due to risks of post-transplant complications. Metabolic bariatric surgery, the most efficient and durable weight loss method, can facilitate a timely kidney transplant listing and improve obesity-related comorbidities in a relatively safe manner. In this review, we identify kidney transplant candidates who are likely to benefit from MBS, discuss the potential risks of this procedure, and propose post-surgery monitoring and management to optimize safety and maximize the benefits of this therapy.