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 Rosen, Julie Heimbach

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28 Scopus citations

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

ASJC Scopus subject areas

  • Hepatology

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    Zamora-Valdes, D., Watt, K. D., Kellogg, T. A., Poterucha, J. J., Di Cecco, S. R., Francisco-Ziller, N. M., Taner, T., Rosen, C., & Heimbach, J. (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