Long-term outcomes of patients undergoing simultaneous liver transplantation and sleeve gastrectomy

Daniel Zamora-Valdes, Kymberly D. Watt, Todd A. Kellogg, John J. Poterucha, Sara R. Di Cecco, Nicki M. Francisco-Ziller, Timucin Taner, Charles B. Rosen, Julie K. Heimbach

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Abstract

Obesity is increasingly common before and after liver transplantation (LT), yet optimal management remains unclear. The aim of this study was to analyze the long-term outcomes for obese patients undergoing LT, including a noninvasive weight loss program and combined LT and sleeve gastrectomy (SG). Since 2006, all patients referred for LT with a body mass index (BMI) ≥35 kg/m2 were enrolled. Patients who achieved weight loss (BMI <35) underwent LT alone, and those who did not underwent simultaneous LT + SG. Analysis of long-term outcomes for patients ≥3 years posttransplant was performed. Since 2006, there were 36 in the weight loss intervention (LT cohort) and 13 in the LT + SG cohort with >3 years of follow-up, whereas overall, a total of 29 patients underwent LT + SG. Patients in the LT cohort had less severe obesity at enrollment (40.0 ± 2.7 vs. LT + SG cohort 46.0 ± 4.5; P < 0.001). In the LT cohort, 83.3% (30 of 36) achieved >10% loss in total body weight (TBW) pre-LT. Three years posttransplant, 29.4% of patients in the LT cohort maintained >10% loss in TBW, whereas 100% of the LT + SG patients did (P < 0.001). Patients who underwent LT + SG maintained a significantly higher percentage of total body weight loss after 3 years of follow-up (LT cohort 3.9 ± 13.3% vs. LT + S G cohort 34.8 ± 17.3%; P < 0.001). Patients in the LT + SG also had a lower prevalence of hypertension, insulin resistance, and hepatic steatosis and required fewer antihypertensive medications and lipid agents at last follow-up. Conclusion: Whereas weight loss before transplantation was achieved by obese patients, weight regain was common in the LT cohort. Combined LT + SG resulted in more effective and more durable weight loss, as well as fewer metabolic complications at last follow-up. (Hepatology 2018).

Original languageEnglish (US)
Pages (from-to)485-495
Number of pages11
JournalHepatology
Volume68
Issue number2
DOIs
StatePublished - Aug 1 2018

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Gastrectomy
Liver Transplantation
Weight Loss
Body Weight
Body Mass Index
Weight Reduction Programs
Morbid Obesity
Gastroenterology
Antihypertensive Agents
Insulin Resistance

ASJC Scopus subject areas

  • Hepatology

Cite this

Zamora-Valdes, D., Watt, K. D., Kellogg, T. A., Poterucha, J. J., Di Cecco, S. R., Francisco-Ziller, N. M., ... Heimbach, J. K. (2018). Long-term outcomes of patients undergoing simultaneous liver transplantation and sleeve gastrectomy. Hepatology, 68(2), 485-495. https://doi.org/10.1002/hep.29848

Long-term outcomes of patients undergoing simultaneous liver transplantation and sleeve gastrectomy. / Zamora-Valdes, Daniel; Watt, Kymberly D.; Kellogg, Todd A.; Poterucha, John J.; Di Cecco, Sara R.; Francisco-Ziller, Nicki M.; Taner, Timucin; Rosen, Charles B.; Heimbach, Julie K.

In: Hepatology, Vol. 68, No. 2, 01.08.2018, p. 485-495.

Research output: Contribution to journalArticle

Zamora-Valdes, D, Watt, KD, Kellogg, TA, Poterucha, JJ, Di Cecco, SR, Francisco-Ziller, NM, Taner, T, Rosen, CB & Heimbach, JK 2018, 'Long-term outcomes of patients undergoing simultaneous liver transplantation and sleeve gastrectomy', Hepatology, vol. 68, no. 2, pp. 485-495. https://doi.org/10.1002/hep.29848
Zamora-Valdes D, Watt KD, Kellogg TA, Poterucha JJ, Di Cecco SR, Francisco-Ziller NM et al. Long-term outcomes of patients undergoing simultaneous liver transplantation and sleeve gastrectomy. Hepatology. 2018 Aug 1;68(2):485-495. https://doi.org/10.1002/hep.29848
Zamora-Valdes, Daniel ; Watt, Kymberly D. ; Kellogg, Todd A. ; Poterucha, John J. ; Di Cecco, Sara R. ; Francisco-Ziller, Nicki M. ; Taner, Timucin ; Rosen, Charles B. ; Heimbach, Julie K. / Long-term outcomes of patients undergoing simultaneous liver transplantation and sleeve gastrectomy. In: Hepatology. 2018 ; Vol. 68, No. 2. pp. 485-495.
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abstract = "Obesity is increasingly common before and after liver transplantation (LT), yet optimal management remains unclear. The aim of this study was to analyze the long-term outcomes for obese patients undergoing LT, including a noninvasive weight loss program and combined LT and sleeve gastrectomy (SG). Since 2006, all patients referred for LT with a body mass index (BMI) ≥35 kg/m2 were enrolled. Patients who achieved weight loss (BMI <35) underwent LT alone, and those who did not underwent simultaneous LT + SG. Analysis of long-term outcomes for patients ≥3 years posttransplant was performed. Since 2006, there were 36 in the weight loss intervention (LT cohort) and 13 in the LT + SG cohort with >3 years of follow-up, whereas overall, a total of 29 patients underwent LT + SG. Patients in the LT cohort had less severe obesity at enrollment (40.0 ± 2.7 vs. LT + SG cohort 46.0 ± 4.5; P < 0.001). In the LT cohort, 83.3{\%} (30 of 36) achieved >10{\%} loss in total body weight (TBW) pre-LT. Three years posttransplant, 29.4{\%} of patients in the LT cohort maintained >10{\%} loss in TBW, whereas 100{\%} of the LT + SG patients did (P < 0.001). Patients who underwent LT + SG maintained a significantly higher percentage of total body weight loss after 3 years of follow-up (LT cohort 3.9 ± 13.3{\%} vs. LT + S G cohort 34.8 ± 17.3{\%}; P < 0.001). Patients in the LT + SG also had a lower prevalence of hypertension, insulin resistance, and hepatic steatosis and required fewer antihypertensive medications and lipid agents at last follow-up. Conclusion: Whereas weight loss before transplantation was achieved by obese patients, weight regain was common in the LT cohort. Combined LT + SG resulted in more effective and more durable weight loss, as well as fewer metabolic complications at last follow-up. (Hepatology 2018).",
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AU - Watt, Kymberly D.

AU - Kellogg, Todd A.

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AU - Di Cecco, Sara R.

AU - Francisco-Ziller, Nicki M.

AU - Taner, Timucin

AU - Rosen, Charles B.

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N2 - Obesity is increasingly common before and after liver transplantation (LT), yet optimal management remains unclear. The aim of this study was to analyze the long-term outcomes for obese patients undergoing LT, including a noninvasive weight loss program and combined LT and sleeve gastrectomy (SG). Since 2006, all patients referred for LT with a body mass index (BMI) ≥35 kg/m2 were enrolled. Patients who achieved weight loss (BMI <35) underwent LT alone, and those who did not underwent simultaneous LT + SG. Analysis of long-term outcomes for patients ≥3 years posttransplant was performed. Since 2006, there were 36 in the weight loss intervention (LT cohort) and 13 in the LT + SG cohort with >3 years of follow-up, whereas overall, a total of 29 patients underwent LT + SG. Patients in the LT cohort had less severe obesity at enrollment (40.0 ± 2.7 vs. LT + SG cohort 46.0 ± 4.5; P < 0.001). In the LT cohort, 83.3% (30 of 36) achieved >10% loss in total body weight (TBW) pre-LT. Three years posttransplant, 29.4% of patients in the LT cohort maintained >10% loss in TBW, whereas 100% of the LT + SG patients did (P < 0.001). Patients who underwent LT + SG maintained a significantly higher percentage of total body weight loss after 3 years of follow-up (LT cohort 3.9 ± 13.3% vs. LT + S G cohort 34.8 ± 17.3%; P < 0.001). Patients in the LT + SG also had a lower prevalence of hypertension, insulin resistance, and hepatic steatosis and required fewer antihypertensive medications and lipid agents at last follow-up. Conclusion: Whereas weight loss before transplantation was achieved by obese patients, weight regain was common in the LT cohort. Combined LT + SG resulted in more effective and more durable weight loss, as well as fewer metabolic complications at last follow-up. (Hepatology 2018).

AB - Obesity is increasingly common before and after liver transplantation (LT), yet optimal management remains unclear. The aim of this study was to analyze the long-term outcomes for obese patients undergoing LT, including a noninvasive weight loss program and combined LT and sleeve gastrectomy (SG). Since 2006, all patients referred for LT with a body mass index (BMI) ≥35 kg/m2 were enrolled. Patients who achieved weight loss (BMI <35) underwent LT alone, and those who did not underwent simultaneous LT + SG. Analysis of long-term outcomes for patients ≥3 years posttransplant was performed. Since 2006, there were 36 in the weight loss intervention (LT cohort) and 13 in the LT + SG cohort with >3 years of follow-up, whereas overall, a total of 29 patients underwent LT + SG. Patients in the LT cohort had less severe obesity at enrollment (40.0 ± 2.7 vs. LT + SG cohort 46.0 ± 4.5; P < 0.001). In the LT cohort, 83.3% (30 of 36) achieved >10% loss in total body weight (TBW) pre-LT. Three years posttransplant, 29.4% of patients in the LT cohort maintained >10% loss in TBW, whereas 100% of the LT + SG patients did (P < 0.001). Patients who underwent LT + SG maintained a significantly higher percentage of total body weight loss after 3 years of follow-up (LT cohort 3.9 ± 13.3% vs. LT + S G cohort 34.8 ± 17.3%; P < 0.001). Patients in the LT + SG also had a lower prevalence of hypertension, insulin resistance, and hepatic steatosis and required fewer antihypertensive medications and lipid agents at last follow-up. Conclusion: Whereas weight loss before transplantation was achieved by obese patients, weight regain was common in the LT cohort. Combined LT + SG resulted in more effective and more durable weight loss, as well as fewer metabolic complications at last follow-up. (Hepatology 2018).

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