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Obesity Surgery

, Volume 19, Issue 10, pp 1460–1463 | Cite as

Intragastric Balloon Followed by Biliopancreatic Diversion in a Liver Transplant Recipient: A Case Report

  • Paolo GentileschiEmail author
  • Marco Venza
  • Domenico Benavoli
  • Francesca Lirosi
  • Ida Camperchioli
  • Marco D’Eletto
  • Alessandra Lazzaro
  • Vito M. Stolfi
  • Alessandro Anselmo
  • Nicola Di Lorenzo
  • Giuseppe Tisone
  • Achille L. Gaspari
Case Report

Abstract

Liver transplantation is a life-saving procedure for end-stage liver disease. In liver transplant recipients, morbid obesity influences post-operative survival and graft function. In 1996, our patient underwent a successful liver transplantation because of a HCV-related liver failure (body mass index (BMI) 31). Follow-up showed a functional graft and the development of severe obesity up to a BMI of 61 in January 2006. In January 2007, he was submitted to intragastric balloon therapy for 6 months, reaching a BMI of 54. In September 2007, he underwent a biliopancreatic diversion. During follow-up to March 2008, he reached a BMI of 42 with ameliorations of comorbidities. In May 2008, during a hospital admission, he suddenly died of a heart attack. Post mortem study revealed a myocardial infarction. This is the first world case report for this approach. According to our opinion, patient’s death was not related to bariatric surgery.

Keywords

Liver transplantation Morbid obesity Biliopancreatic diversion 

References

  1. 1.
    Deitel M, Shikora SA. The development of the surgical treatment of morbid obesity. J Am Coll Nutr. 2002;21(5):365–71.CrossRefGoogle Scholar
  2. 2.
    Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142(7):547–59.CrossRefGoogle Scholar
  3. 3.
    Ong JP, Elariny H, Collantes R, et al. Predictors of nonalcoholic steatohepatitis and advanced fibrosis in morbidly obese patients. Obes Surg. 2005;15:310–5.CrossRefGoogle Scholar
  4. 4.
    Scopinaro N, Adami GF, Marinari GM, et al. Biliopancreatic diversion. World J Surg. 1998;22:936–46.CrossRefGoogle Scholar
  5. 5.
    Butte JM, Devaud N, Jarufe NP, et al. Sleeve gastrectomy as treatment for severe obesity after orthotopic liver transplantation. Obes Surg. 2007;17(11):1517–9.CrossRefGoogle Scholar
  6. 6.
    Spyropoulos C, Katsakoulis E, Mead N, et al. Intragastric balloon for high-risk super-obese patients: a prospective analysis of efficacy. Surg Obes Relat Dis. 2007;3(1):78–83.CrossRefGoogle Scholar
  7. 7.
    Guedea ME, Arribas del Amo D, Solanas JA, et al. Results of biliopancreatic diversion after five years. Obes Surg. 2004;14(6):766–72.CrossRefGoogle Scholar
  8. 8.
    Keeffe EB, Gettys C, Esquivel CO. Liver transplantation in patients with severe obesity. Transplantation. 1994;57:309.CrossRefGoogle Scholar
  9. 9.
    Guckelberger O, Bechstein WO, Neuhaus R, et al. Cardiovascular risk factors in long-term follow-up after orthotopic liver transplantation. Clin Transpl. 1997;11:60.Google Scholar
  10. 10.
    Sawyer RG, Pelletier SJ, Pruett TL. Increased early morbidity and mortality with acceptable long-term function in severely obese patients undergoing liver transplantation. Clin Transpl. 1999;13:126.CrossRefGoogle Scholar
  11. 11.
    Duchini A, Brunson ME. Roux-en-Y gastric bypass for recurrent nonalcoholic steatohepatitis in liver transplant recipients with morbid obesity. Transplantation. 2001;72(1):156–9.CrossRefGoogle Scholar
  12. 12.
    Everhart JE, Lombardero M, Lake JR, et al. Weight change and obesity after liver transplantation: incidence and risk factors. Liver Transpl Surg. 1998;4:285.CrossRefGoogle Scholar
  13. 13.
    Hibberd AD, Trevillian PR, Roger SD, et al. Assessment of the bioequivalence of a generic cyclosporine A by a randomized controlled trial in stable renal recipients. Transplantation. 2006;15(81):711–7.CrossRefGoogle Scholar
  14. 14.
    Deogracias ML, Dominguez-Diez A, Palomar-Fontanet R, et al. Biliopancreatic diversion in a renal transplant patient. Obes Surg. 2007;17:553–5.CrossRefGoogle Scholar
  15. 15.
    Malinowski SS. Nutritional and metabolic complications of bariatric surgery. Am J Med Sci. 2006;331(4):219–25.CrossRefGoogle Scholar
  16. 16.
    Bianchi G, Marchesini G, Marzocchi R, et al. Metabolic syndrome in liver transplantation: relation to etiology and immunosuppression. Liver Transpl. 2008;14:1648–54.CrossRefGoogle Scholar
  17. 17.
    Perkins JD. Influence of obesity with concurrent diseases on liver transplant survival. Liver Transpl. 2007;13:928–9.PubMedGoogle Scholar
  18. 18.
    Wang J, Zhang Z-R, Chou C-F, et al. Cyclosporine stimulates the renal epithelial sodium channel by elevating cholesterol. Am J Physiol Renal Physiol. 2009;296:F284–90.CrossRefGoogle Scholar
  19. 19.
    Moreno Planas JM, Rubio Gonzales E, Herreros de Tejada A, et al. Late mortality in patients with liver transplantation: causes and risk factors. Transplant Proc. 2003;35:707–8.CrossRefGoogle Scholar
  20. 20.
    Lukes DJ, Herlenius G, Rizell M, et al. Late mortality in 679 consecutive liver transplant recipients: the Gothenburg liver transplant experience. Transplant Proc. 2006;38:2671–2.CrossRefGoogle Scholar
  21. 21.
    Pan C, Jain A, Fung JJ. Analysis of causes of late mortality in liver transplant recipients. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2004;16:547.PubMedGoogle Scholar
  22. 22.
    Pruthi J, Medkiff KA, Esrason KT, et al. Analysis of causes of death in liver transplant recipients who survived more than 3 years. Liver Transpl. 2001;7(9):811–5.CrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2009

Authors and Affiliations

  • Paolo Gentileschi
    • 1
    Email author
  • Marco Venza
    • 1
  • Domenico Benavoli
    • 1
  • Francesca Lirosi
    • 1
  • Ida Camperchioli
    • 1
  • Marco D’Eletto
    • 1
  • Alessandra Lazzaro
    • 1
  • Vito M. Stolfi
    • 1
  • Alessandro Anselmo
    • 2
  • Nicola Di Lorenzo
    • 1
  • Giuseppe Tisone
    • 2
  • Achille L. Gaspari
    • 1
  1. 1.Department of SurgeryUniversity of Tor VergataRomeItaly
  2. 2.Liver Transplant UnitUniversity of Tor VergataRomeItaly

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