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Combined Sleeve Gastrectomy with Liver Transplant in Patients with Obesity: a Feasibility Study

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Abstract

Background

Nonalcoholic steatohepatitis (NASH) associated with obesity is one of the leading causes of liver failure requiring transplant, yet guidelines for the management of obesity in these scenarios are not always followed. In order to decrease incidence of NASH in the new liver, we studied the feasibility of simultaneous liver transplant and bariatric surgery.

Materials and Methods

We retrospectively identified patients who underwent simultaneous liver transplant and sleeve gastrectomy at our hospital site between November 24, 2019, and April 14, 2022. Demographics, surgical data, postoperative adverse events, and weight loss data were collected.

Results

Ten patients met inclusion criteria. Mean body mass index (BMI) at the time of transplant was 43.1 ± 5.3 kg/m2, and mean length of hospital stay was 10.8 ± 5.22 days. Within 30 days after surgery, 7 patients reported adverse effects, and 2 were readmitted. Mean BMI at 6-month follow-up was 30.6 ± 2.5 kg/m2. Mean percentage excess weight (in pounds) loss was 48.1 ± 11.4%, 58.6 ± 8.9%, and 66.1 ± 15.3% at 3-, 6-, and 12-month follow-up, respectively. Three patients had an increase in weight at 12-month follow-up when compared to 6-month follow-up. Most patients required fewer comorbidity-related medications, and none reported adverse effects related to sleeve gastrectomy.

Conclusions

Bariatric surgery at the time of liver transplant is safe and has minimal adverse effects. Results include substantial postoperative weight loss, improvement in comorbidities, and decreased risk of NASH in the new liver. Further studies with larger cohorts are required to confirm the findings of this study.

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Abbreviations

%EWL:

Percentage excess weight loss

BMI:

Body mass index

NASH:

Nonalcoholic steatohepatitis

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Authors and Affiliations

  1. Department of General Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA

    Naga Swati Gunturu, Rocio Castillo-Larios, Steven Bowers, Michael Edwards & Enrique F. Elli

  2. Department of Transplant, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA

    Justin Burns & Danna Perry

Authors
  1. Naga Swati Gunturu
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  2. Rocio Castillo-Larios
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  3. Steven Bowers
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  4. Michael Edwards
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  5. Justin Burns
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  6. Danna Perry
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  7. Enrique F. Elli
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Corresponding author

Correspondence to Enrique F. Elli.

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Conclusion

Simultaneous liver transplant and sleeve gastrectomy are feasible, safe, and do not add risks or adverse events to regular liver transplantation surgery. This combined procedure also effectively reduces body weight and controls obesity-associated comorbidities. More studies with larger cohorts are needed to evaluate long-term outcomes of combined surgery so that future programs providing simultaneous bariatric surgery to obese patients undergoing liver transplant can be developed.

Ethical Approval

For this type of study, formal consent is not required.

Informed Consent

Informed consent does not apply.

Conflict of Interest

The authors declare no competing interests.

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Key Points

Obesity is both a major cause and a common adverse effect of liver transplant.

Simultaneous liver transplant and sleeve gastrectomy are feasible and safe.

It also effectively reduces body weight and obesity-associated comorbidities.

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Gunturu, N.S., Castillo-Larios, R., Bowers, S. et al. Combined Sleeve Gastrectomy with Liver Transplant in Patients with Obesity: a Feasibility Study. OBES SURG 32, 3600–3604 (2022). https://doi.org/10.1007/s11695-022-06289-1

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  • DOI: https://doi.org/10.1007/s11695-022-06289-1

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