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.

Impact of Having a Planned Additional Operation at Time of Liver Transplant on Graft and Patient Outcomes

“…Our study showed a longer median operative time in LT+ patients in comparison to LT only (451 vs. 355 min, p = 0.002). Previous studies showed a slightly longer, albeit statistically insignificant, median operative time in patients undergoing an additional splenectomy or sleeve gastrectomy at time of LT by 34-48 min [12,14,25,26]. The statistically significant difference in operative time between our LT+ and LT only patients is likely a reflection of the greater range and complexity of additional operations included in the study (e.g., colectomies, coronary artery bypass graft, cardiac valve replacements, and Whipple procedure).…”

“…The outcomes of patients receiving an additional operation at the same time as LT have not been extensively studied, with the majority of current literature limited to small case series focusing on specific operations only [12][13][14][15][16][17][18][19]. This study aims to compare patients who underwent an additional operation at the same time as their LT to patients who underwent LT alone in terms of donor and recipient characteristics as well as short-term and long-term outcomes.…”

Clinical considerations in the management of non-alcoholic steatohepatitis cirrhosis pre- and post-transplant: A multi-system challenge

“…Only 1 patient had a complication related to the bariatric surgery procedure, a leak at the gastric staple line. Since this initial report, a few more small case series have been published with similar findings[ 116 , 117 ]. Zamora-Valdes et al[ 118 ] recently updated the long-term results from the initial study, reporting that patients who underwent combined transplantation and sleeve gastrectomy maintained weight loss and had a lower incidence of diabetes, hypertension, and hepatic steatosis at 3 years after LT than did those who had pre-LT weight loss without bariatric surgery.…”

Obesity does not significantly impact outcomes following simultaneous liver kidney transplantation: review of the UNOS database - a retrospective study

“…The Mayo Clinic has performed the largest series of liver transplantation immediately followed by sleeve gastrectomy and have obtained excellent long‐term results . A recent series from Israel confirmed the feasibility of performing a combined liver transplant and sleeve gastrectomy . Many of these patients had a significant amount of weight loss that was largely maintained in the long‐term.…”