Sleeve Gastrectomy After Liver Transplantation: Feasibility and Outcomes

Osseis, Michael; Lazzati, Andrea; Salloum, Chady; Gavara, Concepcion Gomez; Compagnon, Philippe; Féray, Cyrille; Lim, Chetana; Azoulay, Daniel

doi:10.1007/s11695-017-2843-y

Cited by 42 publications

(27 citation statements)

References 27 publications

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“…These findings are comparable to %EWL seen in the nontransplant population that range from 53.3% in LSG and 62.6% in RYGB . In the post‐LT population, %EWL ranges from 43% to 76% in studies with a minimum of 12‐month follow‐up . In a recent series of 12 patients who underwent LSG following LT, Tsamalaidze et al demonstrated a change in BMI similar to a matched non‐LT cohort and a %EWL of 50% at 1 year .…”

Section: Discussionmentioning

confidence: 52%

“…Operating on this complex patient population is not without risks, and the complication rate has been cited as up to 40%. These complications include infection, staple line leaks, reoperation, and even death . In the previously largest study of LSG after LT, Tsamalaidze et al observed a major complication rate of 25% and no reoperations or deaths .…”

Section: Discussionmentioning

confidence: 99%

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Delayed Sleeve Gastrectomy Following Liver Transplantation: A 5‐Year Experience

et al. 2019

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Obesity has become an epidemic in the United States over the past decade, and recent studies have shown this trend in the liver transplantation (LT) population. These patients may be candidates for laparoscopic sleeve gastrectomy (LSG) to promote significant and sustained weight loss to prevent recurrence of nonalcoholic steatohepatitis. However, safety remains a concern, and efficacy in this setting is uncertain. A single‐institution database from 2014 to 2018 was queried for patients undergoing LSG following LT. The selection criteria for surgery were consistent with National Institutes of Health guidelines, and patients were at least 6 months after LT. A total of 15 patients (median age, 59.0 years; Caucasian, 86.7%; and female, 60%) underwent LSG following LT. Median time from LT to LSG was 2.2 years with a median follow‐up period of 2.6 years. The median hospital length of stay (LOS) was 2 days after LSG. Mortality and rate of liver allograft rejection was 0, and there was 1 postoperative complication (a surgical site infection). Following LSG, body mass index (BMI) decreased from 42.7 to 35.9 kg/m2 (P < 0.01), and in 12 patients with at least 1 year of follow‐up, the total body weight loss was 20.6%. Following LSG in patients with diabetes, the median daily insulin requirements decreased from 98 (49‐118) to 0 (0‐29) units/day (P = 0.02), and 60% discontinued insulin. Post‐LT patients had a similar decrease in BMI and reduction in comorbidities at 1 year compared with a matched non‐LT patient cohort. In the largest patient series to date, we show that LSG following LT is safe, effective, and does not increase the incidence of liver allograft rejection. Larger longer‐term studies are needed to confirm underlying metabolic changes following LSG.

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Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Delayed Sleeve Gastrectomy Following Liver Transplantation: A 5‐Year Experience

et al. 2019

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“…92,93 The first reported case of simultaneous SG with a living donor LT recipient was described in 2017, resulting in posttransplant weight loss to BMI < 30 kg/m 2 within 2 months, as well as cure of DM. 94 in those with a prior LT. 96 Other smaller series of D-LT note similar efficacy with weight loss and metabolic complications, though adhesions, bleeding issues, and longer operative time were described. 55,96-98…”

Section: Treatment Options For Lt Patients With Obesitymentioning

confidence: 95%

Obesity, transplantation, and bariatric surgery: An evolving solution for a growing epidemic

Diwan

Lee

Nagai

et al. 2020

American Journal of Transplantation

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Obesity is a worldwide epidemic. In 2005, 25% of the world population was overweight (as defined by body mass index [BMI] 25-29.9 kg/m 2) and 10% was obese (BMI > 30 kg/m 2). 1 By 2030, the prevalence is projected to reach 38% overweight and 20% obese. In the United States, the rates of obesity in 2014 were 35% of men and 40% of women. 2 The health-related ramifications of obesity have been well documented, including but not limited to cardiovascular disease, diabetes mellitus (DM), and cancer. 3-5 In patients with end-organ disease, obesity-related comorbidities can influence access to transplant, technical aspects of the transplant operations, and posttransplant outcome. Although class 1 obesity (BMI 30-34.9 kg/m 2) is not typically a contraindication, class 2 (BMI 35-39.9 kg/m 2) and class 3 (BMI > 40 kg/ m 2) obesity can be relative or absolute contraindications to transplant. Findings from a survey of

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“…and improved long-term patient and graft survival. [6][7][8][9][10][11][12][13][14][15][16][17] Furthermore, benefits among specific organ transplant subtypes include stabilization or improvement in kidney graft function for kidney transplant recipients and decreased liver graft steatosis and fibrosis for liver transplant recipients with history of nonalcoholic fatty liver disease. [18][19][20][21] However, the perioperative safety of bariatric surgery among patients with history of solid organ transplant is poorly understood, because small studies have poor generalizability and may fail to detect rare events.…”

Section: Introductionmentioning

confidence: 99%

“…Reported short-term complications in single-center studies include anastomotic leak, bleeding, infection, unplanned reoperation, intensive care unit stay, and death. 6,8,[14][15][16][17]21,22 Yet these studies have no comparison cohorts, and therefore the marginal risk of these outcomes imparted by previous solid organ transplant status remains unknown. Preoperative kidney disease is more common in solid organ transplant recipients, adding to the baseline perioperative risk.…”

Section: Introductionmentioning

confidence: 99%

Perioperative risks of bariatric surgery among patients with and without history of solid organ transplant

Montgomery

Cohen

Brown

et al. 2020

American Journal of Transplantation

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Bariatric surgery is effective among patients with previous transplant in limited case series. However, the perioperative safety of bariatric surgery in this patient population is poorly understood. Therefore, we assessed the safety of bariatric surgery among previous‐transplant patients using a database that captures >92% of all US bariatric procedures. All primary, laparoscopic sleeve gastrectomy and Roux‐en‐Y gastric bypass procedures between 2017 and 2018 were identified from the MBSAQIP dataset. Patients with previous transplant (n = 610) were compared with patients without previous transplant (n = 321 447). Primary outcomes were 30 day readmissions, surgical complications, medical complications, and death. Multivariable logistic regression with predictive margins was used to compare outcomes. Previous transplant patients experienced higher incidence of readmissions (8.0% vs 3.5%), surgical complications (5.0% vs 2.7%), and medical complications (4.3% vs 1.5%). There was no difference in incidence of death (0.2% vs 0.1%). Among individual complications, there no statistical differences in intraabdominal leak, unplanned reoperation, myocardial infarction, or infectious complications. Baseline estimated glomerular filtration rate was found to be a strong moderator of primary outcomes, with the highest risk of complications occurring at the lowest baseline estimated glomerular filtration rate. Given the many long‐term benefits of bariatric surgery among patients with previous transplant, our findings should not preclude this patient population from operative consideration.

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Sleeve Gastrectomy After Liver Transplantation: Feasibility and Outcomes

Abstract: SG is technically feasible after LT and resulted in weight loss without adversely affecting graft function and immunosuppression. However, morbidity and mortality are high.

Cited by 42 publications

References 27 publications

Delayed Sleeve Gastrectomy Following Liver Transplantation: A 5‐Year Experience

Delayed Sleeve Gastrectomy Following Liver Transplantation: A 5‐Year Experience

Obesity, transplantation, and bariatric surgery: An evolving solution for a growing epidemic

Perioperative risks of bariatric surgery among patients with and without history of solid organ transplant

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