title: Simultaneous Liver Transplantation and Sleeve Gastrectomy: Prohibitive Combination or a Necessity?
abstract: Previously, many morbidly obese (MO) patients were denied liver transplantation (LT) because of the higher operative risk. However, nowadays, 5 and 10 years graft survival is the rule, and patients whose lives can be prolonged with LT are dying of obesity-related comorbidities. Recent experience suggests that weight reduction in MO liver transplant recipients would improve their long-term survival. The bariatric surgery before LT is contraindicated for patients with decompensated cirrhosis, while post-transplant intervention is associated with increased technical difficulty. We present our experience with three patients who underwent simultaneous liver transplantation and sleeve gastrectomy. After a median 13 months follow-up, all patients are alive, having normal allograft function and significant weight loss. Combined liver transplantation with simultaneous sleeve gastrectomy appears technically feasible and relatively safe in selected patients.
authors.affiliation: The Department of Transplantation, Rabin Medical Center, Campus Beilinson, Petach Tiqva, Israel.
authors.forename: Eviatar
authors.initials: E
authors.lastname: Nesher
authors.affiliation: The Department of Transplantation, Rabin Medical Center, Campus Beilinson, Petach Tiqva, Israel.
authors.forename: Eytan
authors.initials: E
authors.lastname: Mor
authors.affiliation: The Liver Institute, Rabin Medical Center, Campus Beilinson, Petach Tiqva, Israel.|Department of Medicine D, Rabin Medical Center, Campus Beilinson, Petach Tiqva, Israel.
authors.forename: Amir
authors.initials: A
authors.lastname: Shlomai
authors.affiliation: The Liver Institute, Rabin Medical Center, Campus Beilinson, Petach Tiqva, Israel.
authors.forename: Michal
authors.initials: M
authors.lastname: Naftaly-Cohen
authors.affiliation: Department of General Surgery, Rabin Medical Center, Campus Beilinson, Petach Tiqva, Israel.
authors.forename: Renana
authors.initials: R
authors.lastname: Yemini
authors.affiliation: The Department of Transplantation, Rabin Medical Center, Campus Beilinson, Petach Tiqva, Israel.
authors.forename: Alexander
authors.initials: A
authors.lastname: Yussim
authors.affiliation: The Liver Institute, Rabin Medical Center, Campus Beilinson, Petach Tiqva, Israel.
authors.forename: Marius
authors.initials: M
authors.lastname: Brown
authors.affiliation: Department of General Surgery, Rabin Medical Center, Campus Beilinson, Petach Tiqva, Israel. ndrkdr@gmail.com.|The Department of Surgery, Beilinson Hospital, Jabotinsky 39, Petach Tiqva, Israel. ndrkdr@gmail.com.
authors.forename: Andrei
authors.initials: A
authors.lastname: Keidar
mesh_terms: D015897:Comorbidity; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008107:Liver Diseases / Q000150:complications / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery
keywords: Bariatric surgery; Liver cirrhosis; Liver transplantation; Non-alcoholic steatohepatitis; Sleeve gastrectomy