Liver transplantation for decompensated cirrhosis after jejunoileal bypass: a strategy for management.
BACKGROUND
Although jejunoileal bypass results in end-stage liver disease in up to 100% of patients, little is known about outcome after liver transplantation.


METHODS
The clinical courses of six patients who underwent liver transplantation at UCLA for decompensated cirrhosis owing to a jejunoileal bypass were reviewed. Liver function, allograft pathology, renal function, and nutritional status were assessed.


RESULTS
Of the four patients with an intact jejunoileal bypass, two of the three who were biopsied had recurrent steatotic liver disease. The two patients whose jejunoileal bypass was reversed at the time of liver transplantation had lower alkaline phosphatase, lower creatinine, higher albumin, and higher cholesterol, and were more obese than their counterparts with intact bypasses.


CONCLUSIONS
Patients undergoing liver transplantation for jejunoileal bypass-associated liver disease should, if possible, have their bypass reversed at the time of transplantation; otherwise, they must be followed closely and be biopsied routinely. Recurrent liver disease should prompt reversal of the jejunoileal bypass.
Markowitz
J S
JS
Department of Surgery, UCLA Medical Center, Los Angeles, California 90095, USA.
Seu
P
P
Goss
J A
JA
Yersiz
H
H
Markmann
J F
JF
Farmer
D G
DG
Ghobrial
R M
RM
Goldstein
L I
LI
Martin
P
P
Stribling
R
R
Busuttil
R W
RW
D000328:Adult; D001706:Biopsy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007581:Jejunoileal Bypass / Q000009:adverse effects*; D008103:Liver Cirrhosis / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D008111:Liver Function Tests; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012008:Recurrence