title: Combined liver transplantation and gastric sleeve resection for patients with medically complicated obesity and end-stage liver disease.
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.
authors.affiliation: William J von Liebig Transplant Center.
authors.forename: J K
authors.initials: JK
authors.lastname: Heimbach
authors.forename: K D S
authors.initials: KD
authors.lastname: Watt
authors.forename: J J
authors.initials: JJ
authors.lastname: Poterucha
authors.forename: N Francisco
authors.initials: NF
authors.lastname: Ziller
authors.forename: S D
authors.initials: SD
authors.lastname: Cecco
authors.forename: M R
authors.initials: MR
authors.lastname: Charlton
authors.forename: J E
authors.initials: JE
authors.lastname: Hay
authors.forename: R H
authors.initials: RH
authors.lastname: Wiesner
authors.forename: W
authors.initials: W
authors.lastname: Sanchez
authors.forename: C B
authors.initials: CB
authors.lastname: Rosen
authors.forename: J M
authors.initials: JM
authors.lastname: Swain
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D004724:Endoscopy / Q000379:methods; D005260:Female; D005743:Gastrectomy / Q000379:methods; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D017093:Liver Failure / Q000150:complications / Q000628:therapy*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000601:surgery*; D012307:Risk Factors; D016896:Treatment Outcome; D015431:Weight Loss