title: Feasibility and outcomes of laparoscopic sleeve gastrectomy after solid organ transplantation.
abstract: BACKGROUND
  Obesity is common after solid organ transplantation and is associated with worse transplantation-related outcomes. Laparoscopic sleeve gastrectomy (LSG) may be the preferred bariatric operation in transplantation patients over other techniques, such as gastric bypass, given the concerns about medication absorption. However, little is known about LSG outcomes in post-transplantation patients.
  
  
  OBJECTIVE
  We report the outcomes in 10 consecutive patients who underwent solid organ transplantation followed by LSG.
  
  
  METHODS
  An academic medical center.
  
  
  METHODS
  Primary outcomes studied were weight loss, perioperative complications, resolution or improvement of obesity-related co-morbidities, and markers of graft function following LSG.
  
  
  RESULTS
  The types of transplantation before LSG were as follows: liver = 5, kidney = 4, and heart = 1. Mean body mass index (BMI) at LSG was 44.7 ± 1.7 kg/m(2). All patients had hypertension, and 6 had type 2 diabetes. Perioperative complications occurred in 2 patients, and there were no deaths. Excess weight loss at 12 and 24 months after LSG was 45.7% and 42.5%, respectively. At 1 year after LSG, there was a significant reduction in the number of antihypertensive medications (2.4 to 1.5; P = .02). Three patients achieved complete remission of type 2 diabetes, and the other 3 significantly reduced their dosages of insulin. Graft function remained preserved in liver transplantation patients; left ventricular ejection fraction (LVEF) increased by 10% in the heart transplantation subject, and the estimated glomerular filtration rate (eGFR) increased significantly in kidney transplantation patients (53 ± 3 to 82 ± 3 mL/min; P = .03).
  
  
  CONCLUSIONS
  We concluded that LSG, in selected patients with severe obesity after solid organ transplantation, results in significant weight loss, improvement or resolution of obesity-related conditions, and preservation or improvement of graft function. Larger studies are needed to determine tolerability standards.
authors.affiliation: Department of Surgery, Division of General Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
authors.forename: Jad
authors.initials: J
authors.lastname: Khoraki
authors.affiliation: Department of Surgery, Division of General Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
authors.forename: Micah G
authors.initials: MG
authors.lastname: Katz
authors.affiliation: Department of Surgery, Division of General Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
authors.forename: Luke M
authors.initials: LM
authors.lastname: Funk
authors.affiliation: Department of Surgery, Division of General Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
authors.forename: Jacob A
authors.initials: JA
authors.lastname: Greenberg
authors.affiliation: Department of Surgery, Division of General Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
authors.forename: Luis A
authors.initials: LA
authors.lastname: Fernandez
authors.affiliation: Department of Surgery, Division of General Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. Electronic address: gcampos@mcvh-vcu.edu.
authors.forename: Guilherme M
authors.initials: GM
authors.lastname: Campos
mesh_terms: D018450:Disease Progression; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000209:etiology / Q000601:surgery*; D016377:Organ Transplantation / Q000009:adverse effects*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss
keywords: Bariatric surgery; Graft function; Heart transplantation; Immunosuppression; Kidney transplantation; Laparoscopic sleeve gastrectomy; Liver transplantation; Obesity; Transplantation; Type 2 diabetes