Combined liver transplantation and gastric sleeve resection for patients with medically complicated obesity and end-stage liver disease

J. K. Heimbach, K. D S Watt, J. J. Poterucha, N. Francisco Ziller, S. D. Cecco, M. R. Charlton, J. E. Hay, R. H. Wiesner, W. Sanchez, C. B. Rosen, J. M. Swain

Research output: Contribution to journalArticle

114 Citations (Scopus)

Abstract

Obesity is increasingly common before and after liver transplantation (LT), yet optimal management remains unclear. Our aim was to analyze the effectiveness of a multidisciplinary protocol for obese patients requiring LT, including a noninvasive pretransplant weight loss program, and a combined LT plus sleeve gastrectomy (SG) for obese patients who failed to lose weight prior to LT. Since 2006, all patients referred LT with a BMI > 35 were enrolled. There were 37 patients who achieved weight loss and underwent LT alone, and 7 who underwent LT combined with SG. In those who received LT alone, weight gain to BMI > 35 was seen in 21/34, post-LT diabetes (DM) in 12/34, steatosis in 7/34, with 3 deaths plus 3 grafts losses. In patients undergoing the combined procedure, there were no deaths or graft losses. One patient developed a leak from the gastric staple line, and one had excess weight loss. No patients developed post-LT DM or steatosis, and all had substantial weight loss (mean BMI = 29). Noninvasive pretransplant weight loss was achieved by a majority, though weight gain post-LT was common. Combined LT plus SG resulted in effective weight loss and was associated with fewer post-LT metabolic complications. Long-term follow-up is needed. With a mean follow-up of 17 months, liver transplantation with simultaneous sleeve gastrectomy provided effective weight loss and reduced posttransplant metabolic complications.

Original languageEnglish (US)
Pages (from-to)363-368
Number of pages6
JournalAmerican Journal of Transplantation
Volume13
Issue number2
DOIs
StatePublished - Feb 2013

Fingerprint

End Stage Liver Disease
Liver Transplantation
Stomach
Obesity
Weight Loss
Gastrectomy
Weight Gain
Weight Reduction Programs
Transplants
Fatty Liver

Keywords

  • Bariatric surgery
  • liver transplantation
  • metabolic syndrome
  • obesity
  • sleeve gastrectomy
  • weight gain

ASJC Scopus subject areas

  • Transplantation
  • Immunology and Allergy
  • Pharmacology (medical)

Cite this

Combined liver transplantation and gastric sleeve resection for patients with medically complicated obesity and end-stage liver disease. / Heimbach, J. K.; Watt, K. D S; Poterucha, J. J.; Ziller, N. Francisco; Cecco, S. D.; Charlton, M. R.; Hay, J. E.; Wiesner, R. H.; Sanchez, W.; Rosen, C. B.; Swain, J. M.

In: American Journal of Transplantation, Vol. 13, No. 2, 02.2013, p. 363-368.

Research output: Contribution to journalArticle

Heimbach, JK, Watt, KDS, Poterucha, JJ, Ziller, NF, Cecco, SD, Charlton, MR, Hay, JE, Wiesner, RH, Sanchez, W, Rosen, CB & Swain, JM 2013, 'Combined liver transplantation and gastric sleeve resection for patients with medically complicated obesity and end-stage liver disease', American Journal of Transplantation, vol. 13, no. 2, pp. 363-368. https://doi.org/10.1111/j.1600-6143.2012.04318.x
Heimbach, J. K. ; Watt, K. D S ; Poterucha, J. J. ; Ziller, N. Francisco ; Cecco, S. D. ; Charlton, M. R. ; Hay, J. E. ; Wiesner, R. H. ; Sanchez, W. ; Rosen, C. B. ; Swain, J. M. / Combined liver transplantation and gastric sleeve resection for patients with medically complicated obesity and end-stage liver disease. In: American Journal of Transplantation. 2013 ; Vol. 13, No. 2. pp. 363-368.
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