Are We Ready for Bariatric Surgery in a Liver Transplant Program? A Meta-Analysis

López-López, Víctor; Ruiz-Manzanera, Juan José; Eshmuminov, Dilmurodjon; Lehmann, Kuno; Schneider, Marcel; Groeben, Markus von der; Angulo, David Ruíz de; Gajownik, Ursula; Pons, José Antonio; Sánchez‐Bueno, Francisco; Robles, R; Ramírez-Romero, Pablo

doi:10.1007/s11695-020-05118-7

Cited by 16 publications

(11 citation statements)

References 53 publications

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“…Based on this latter finding, although there is no consensus yet, the approach that is currently best accepted is to perform LT first and bariatric surgery later on [ 98 , 99 ].…”

Section: Bariatric Surgery and Liver Transplantmentioning

confidence: 99%

Bariatric Surgery and Liver Disease: General Considerations and Role of the Gut–Liver Axis

et al. 2021

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Weight loss is a therapeutic solution for many metabolic disorders, such as obesity and its complications. Bariatric surgery aims to achieve lasting weight loss in all patients who have failed after multiple dietary attempts. Among its many benefits, it has been associated with the regression of non-alcoholic fatty liver disease (NAFLD), which is often associated with obesity, with evidence of substantial improvement in tissue inflammation and fibrosis. These benefits are mediated not only by weight loss, but also by favorable changes in systemic inflammation and in the composition of the gut microbiota. Changes in microbial metabolites such as short-chain fatty acids (SCFAs), capable of acting as endocrine mediators, and bile acids (BAs) as well as modifications of the gut-brain axis, are among the involved mechanisms. However, not all bariatric surgeries show beneficial effects on the liver; those leading to malabsorption can cause liver failure or a marked worsening of fibrosis and the development of cirrhosis. Nevertheless, there are still many unclear aspects, including the extent of the benefits and the magnitude of the risks of bariatric surgery in cirrhotic patients. In addition, the usefulness and the safety of these procedures in patients who are candidates to or who have undergone liver transplant need solid supporting evidence. This paper aims to review literature data on the use of bariatric surgery in the setting of chronic liver disease.

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“…Based on this latter finding, although there is no consensus yet, the approach that is currently best accepted is to perform LT first and bariatric surgery later on [ 98 , 99 ].…”

Section: Bariatric Surgery and Liver Transplantmentioning

confidence: 99%

Bariatric Surgery and Liver Disease: General Considerations and Role of the Gut–Liver Axis

et al. 2021

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“…A chronic, silent, obesity-related disease, such as NAFLD, affects mostly patients with a higher BMI, higher prevalence of T2DM, metabolic comorbidities, lower glomerular filtration rate, and most of all, old patients: this represents a consistent problem on LT waiting lists and the patient management before and after the LT [144,[150][151][152].…”

Section: Timing Of Bariatric Surgery and Effects Of Nafld On The Waiting List For Ltmentioning

confidence: 99%

Target Therapies for NASH/NAFLD: From the Molecular Aspect to the Pharmacological and Surgical Alternatives

Finotti

Romano

Auricchio

et al. 2021

JPM

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Non-alcoholic fatty liver disease represents an increasing cause of chronic hepatic disease in recent years. This condition usually arises in patients with multiple comorbidities, the so-called metabolic syndrome. The therapeutic options are multiple, ranging from lifestyle modifications, pharmacological options, to liver transplantation in selected cases. The choice of the most beneficial one and their interactions can be challenging. It is mandatory to stratify the patients according to the severity of their disease to tailor the available treatments. In our contribution, we review the most recent pharmacological target therapies, the role of bariatric surgery, and the impact of liver transplantation on the NAFLD outcome.

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“…BS after LT aims to treat morbid obesity in efforts to reduce the risk of metabolic complications after LT and improving long-term outcomes. Reported series described an interval from LT to BS ranging between 27 and 70 months, 44 45 and thus the safety and effectiveness of BS within the first 2 years of transplant are unknown. Special care with respect to immunosuppression should be taken on planning BS after LT, with restrictive procedures having less effect on absorption than malabsorptive procedures (which may require more careful immunosuppression follow-up).…”

Section: Bariatric Surgery and Liver Transplantationmentioning

confidence: 99%

“…Taken together, however, published data suggest that BS does not significantly alter immunosuppression levels and doses. 45 As with any surgical procedure, patients on mammalian target of rapamycin inhibitors (mTOR inhibitors) would need to be switched to other immunosuppression regimens, 46 due to the high risk of wound complications in patients on these drugs.…”

Section: Bariatric Surgery and Liver Transplantationmentioning

confidence: 99%

Risks and Rewards of Bariatric Surgery in Advanced Chronic Liver Diseases

et al. 2021

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The burden of obesity and metabolic syndrome has determined a sharp increase in bariatric surgery (BS) procedures, which lead to marked weight loss, improved metabolic syndrome, reduced cardiovascular risk, and even improvement in nonalcoholic steatohepatitis (NASH). Despite these promising results, BS in patients with chronic liver disease can rarely lead to worsening of liver function, progression to cirrhosis and its complications, and even liver transplantation. On the other hand, since obesity in patients with cirrhosis is a major cofactor for progression to a decompensated stage of the disease and a risk factor for hepatocellular carcinoma, BS has been used to achieve weight loss in this population. In this review, we critically analyze the existing data on outcomes of BS in patients with cirrhosis and the possible mechanisms leading to fibrosis progression and worsening liver function in patients undergoing BS. Finally, we propose a set of measures that could be taken to improve the multidisciplinary management of liver disease in patients undergoing BS, including early recognition of malnutrition and alcohol misuse.

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Are We Ready for Bariatric Surgery in a Liver Transplant Program? A Meta-Analysis

Cited by 16 publications

References 53 publications

Bariatric Surgery and Liver Disease: General Considerations and Role of the Gut–Liver Axis

Bariatric Surgery and Liver Disease: General Considerations and Role of the Gut–Liver Axis

Target Therapies for NASH/NAFLD: From the Molecular Aspect to the Pharmacological and Surgical Alternatives

Risks and Rewards of Bariatric Surgery in Advanced Chronic Liver Diseases

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