Abstract
Obesity is increasingly common before and after liver transplantation (LT), yet optimal management remains unclear. Our aim was to analyze the effectiveness of a multidisciplinary protocol for obese patients requiring LT, including a noninvasive pretransplant weight loss program, and a combined LT plus sleeve gastrectomy (SG) for obese patients who failed to lose weight prior to LT. Since 2006, all patients referred LT with a BMI > 35 were enrolled. There were 37 patients who achieved weight loss and underwent LT alone, and 7 who underwent LT combined with SG. In those who received LT alone, weight gain to BMI > 35 was seen in 21/34, post-LT diabetes (DM) in 12/34, steatosis in 7/34, with 3 deaths plus 3 grafts losses. In patients undergoing the combined procedure, there were no deaths or graft losses. One patient developed a leak from the gastric staple line, and one had excess weight loss. No patients developed post-LT DM or steatosis, and all had substantial weight loss (mean BMI = 29). Noninvasive pretransplant weight loss was achieved by a majority, though weight gain post-LT was common. Combined LT plus SG resulted in effective weight loss and was associated with fewer post-LT metabolic complications. Long-term follow-up is needed. With a mean follow-up of 17 months, liver transplantation with simultaneous sleeve gastrectomy provided effective weight loss and reduced posttransplant metabolic complications.
Original language | English (US) |
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Pages (from-to) | 363-368 |
Number of pages | 6 |
Journal | American Journal of Transplantation |
Volume | 13 |
Issue number | 2 |
DOIs | |
State | Published - Feb 2013 |
Keywords
- Bariatric surgery
- liver transplantation
- metabolic syndrome
- obesity
- sleeve gastrectomy
- weight gain
ASJC Scopus subject areas
- Immunology and Allergy
- Transplantation
- Pharmacology (medical)