The success of vertical banded gastroplasty (VBG) in the obese transplanted population is measured by a low operative morbidity and mortality in the context of a good record of permanent weight loss and an enhanced quality of life. Selection of transplanted patients for gastroplasty should be guided by the prevailing standards for the general population. VBG is the procedure of choice because of proven efficacy and has the benefit over gastric bypass of not producing malabsorption. The operation causes early satiety while allowing consistent absorption of immunosuppressive medication from the upper gastrointestinal tract, essential in these patients. This risk of hypertension, diabetes mellitus, hyperlipidemia, and immunosuppressive medication toxicity may be decreased by substantial long-term weight loss afforded morbidly obese transplant patients by gastric restrictive surgery. Cardiac risk factors associated with morbid obesity and immunosuppressive therapy are lessened with sustained weight reduction.