Abstract

BACKGROUND: Pre-transplant bariatric surgery in patients with high Model for End-stage Liver Disease (MELD) score is fraught with risks. Bariatric surgery after liver transplant (LT) may be complicated by surgical adhesions but could have advantages if performed at the time of transplant. We investigated a method of brief-interval staging combining LT and sleeve gastrectomy (SG).

METHODS: LT recipients with a body mass index (BMI) >40kg/m2 received a SG during the same hospitalization as the LT (LT/SG), at the same time as a planned brief-interval return to the operating room for biliary anastomosis. Differences in intra-operative attributes of the LT (Stage 1) vs SG (Stage 2) procedures were analyzed using Wilcoxon signed rank with significance p<0.05 and compared to obese having a 2-stage LT without SG.

RESULTS: Fourteen cases (median [IQR]) MELD score 33 [18,40]) were compared with 28 controls; 60% were critically ill prior to surgery with mechanical ventilation, vasopressors, or continuous renal replacement therapy. Median interval between procedures was 16.1 [12.5,22.7] hours for cases and 12.2 [11.1,16.6] hours for controls, p=0.27. Median BMI at LT/SG was 47.0kg/m2 [41.7,51.3] vs 38.1 [35.7,39.8] for controls, p<0.001. At 1-year, median excess body weight loss was 74.0% [46.2,78.7] in cases and 15.8% [-5.4,62.6] in controls, p=0.13; total weight loss was 38.1% [23.9,42.9] in cases vs 7.7 [-2.4,27.6] for controls, p=0.03. Graft survival at 1-year was 92.9% for cases and 89.3% for controls with similar early post-operative outcomes.

CONCLUSION: This proof-of-concept study revealed that a brief-interval SG during LT is feasible in patients with high MELD and resulted in sustained weight loss at 1-year with similar graft survival. Further studies are needed to determine an optimal strategy.

Original languageEnglish (US)
JournalLiver Transplantation
DOIs
StateE-pub ahead of print - Aug 17 2022

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