title: The first Polish liver transplantation after Roux-en-Y gastric bypass surgery for morbid obesity: a case report and literature review.
abstract: BACKGROUND
  Morbid obesity is associated with liver pathology, most commonly non-alcoholic steatohepatitis (NASH) leading to cirrhosis. However, the morbid obesity impedes qualification for organ transplantation.
  
  
  METHODS
  We present a case report of a 56-year-old woman who underwent bariatric procedure followed by liver transplantation (LTx). Her initial weight was 130.2 kg (BMI 50.9 kg/m2). The patient had a history of arterial hypertension, diabetes, gonarthrosis, and obstructive sleep apnea syndrome and no history of alcohol abuse. She underwent Roux-en-Y gastric bypass (RYGB) procedure. The routine intraoperative liver biopsy revealed fibrosis (III°), steatosis (II°), and intra-acinar inﬂammation. The operation led to a substantial loss of weight. Two years after the surgery the patient was referred to the Transplantation Clinic of Department of General Surgery and Transplantology with suspicion of liver failure due to advanced cirrhosis, which could be a result of previously diagnosed NASH and, probably, excessive alcohol use after bariatric surgery. The patient was qualified for elective LTx, which was performed 3 years after the RYGB. Immediately before LTx, the patient's weight was 65 kg (BMI 25.4 kg/m²). The postoperative period was complicated by bleeding into the peritoneal cavity, which required reoperation. She also had renal failure, requiring renal replacement therapy. One year after LTx, she showed stable liver function with normal transaminases activity and bilirubin concentration, remission of diabetes, and good renal function.
  
  
  CONCLUSIONS
  Steatohepatitis in morbidly obese patients may lead to cirrhosis. Bariatric procedure can be a bridge to liver transplantation for morbidly obese patients with advanced liver fibrosis.
authors.affiliation: Department of General Surgery and Transplantology, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Rafał
authors.initials: R
authors.lastname: Marszałek
authors.affiliation: Department of General Surgery and Transplantology, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Paweł
authors.initials: P
authors.lastname: Ziemiański
authors.affiliation: Department of General Surgery and Transplantology, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Beata
authors.initials: B
authors.lastname: Łągiewska
authors.affiliation: Department of General Surgery and Transplantology, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Pacholczyk
authors.affiliation: Department of Internal Medicine and Cardiology with The Centre of Diagnosis and Treatment of Venous Thromboembolic Disease, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Justyna
authors.initials: J
authors.lastname: Domienik-Karłowicz
authors.affiliation: 1st Department of Anesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Janusz
authors.initials: J
authors.lastname: Trzebicki
authors.affiliation: Department of General Surgery and Transplantology, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Wierzbicki
authors.affiliation: Department of Internal Medicine and Cardiology with The Centre of Diagnosis and Treatment of Venous Thromboembolic Disease, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Jankowski
authors.affiliation: Department of General Surgery and Transplantology, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Kosieradzki
authors.affiliation: Department of Surgical and Transplant Nursing, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Dariusz
authors.initials: D
authors.lastname: Wasiak
authors.affiliation: Department of General Surgery and Transplantology, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Maurycy
authors.initials: M
authors.lastname: Jonas
authors.affiliation: Department of Internal Medicine and Cardiology with The Centre of Diagnosis and Treatment of Venous Thromboembolic Disease, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Pruszczyk
authors.affiliation: Department of Transplant Medicine and Nephrology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Durlik
authors.affiliation: Department of General Surgery and Transplantology, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Lisik
authors.affiliation: Department of General Surgery and Transplantology, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Chmura
mesh_terms: D005234:Fatty Liver / Q000150:complications / Q000601:surgery*; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D016031:Liver Transplantation; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome