Clinical and Economic Impact of Previous Bariatric Surgery on Liver Transplantation: a Nationwide, Population-Based Retrospective Study

Abstract

Purpose The present study aims to determine the impact of previous bariatric surgery (BS) on the length of hospital stay; the incidence of mortality, re-transplantation, and re-hospitalization after LT; and the related economic costs, through the analysis of the French National Health Insurance Information System. Materials and Methods All patients aged > 18 years who underwent LT in France in the period from 2010 to 2019 were included. Thirty-nine patients with a history of BS (study group) were compared with 1798 obese patients without previous BS (control group). Results At the time of LT, patients with a history of BS were significantly younger than those of the control group and had lower Charlson comorbidity index. Female sex was significantly more represented in the study group. No significant differences were detected between the two groups regarding the postoperative mortality rate after LT (10.3% in the study group versus 8.0% in the control group), long-term mortality (0.038 versus 0.029 person-year of follow-up, respectively), re-transplantation (adjusted hazard ratio (HR) = 2.15, p = 0.2437), re-hospitalization (adjusted analysis, IRR = 0.93, p = 0.7517), and costs of LT hospitalization (73,515 € in the study group versus 65,878 € in the control group). After 1:2 propensity score matching, the duration of the LT hospital stay was significantly longer in the study group (58.3 versus 33.4 days, p = 0.0172). Conclusion No significant differences were detected between patients with previous BS versus obese patients without history of BS undergoing LT concerning the rates of mortality, re-LT, re-hospitalization after LT, and costs of hospitalization and re-hospitalizations. Graphical abstract

Bariatric surgery and liver transplantation, here we are now: A French nationwide retrospective study

“…Ianelli and coll. compared 39 French LT patients with a history of BS, to 1798 obese LT patients without previous BS [5]. No significant difference was detected between the 2 groups regarding the rates of mortality, re-LT, re-hospitalization after LT, and costs of hospitalization and re-hospitalizations.…”

Bariatric surgery in liver cirrhosis

“…In patients suffering from liver cirrhosis, BS may trigger acute-on-chronic liver failure warranting urgent LT ( 39 – 41 ). Iannelli et al identified more patients with acute-on-chronic liver failure after BS, requiring high urgency LT ( 42 ). This emphasizes that BS, no matter which procedure is chosen, is a high-risk procedure in morbidly obese patients with liver cirrhosis ( 25 ).…”