Long-term outcomes of patients undergoing simultaneous Liver Transplantation and Sleeve Gastrectomy

Abstract

Background: Obesity is increasingly common before and after liver transplantation (LT), yet optimal management remains unclear. Aim: To analyze the long term outcomes for obese patients undergoing LT including a non-invasive weight loss program and combined LT and sleeve gastrectomy (SG). Methods: 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 after transplant was performed. Results: 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, while 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% (30/36) achieved >10% loss in total body weight (TBW) prior to LT. Three years after transplant, 29.4% of patients in LT cohort maintained >10% loss in TBW, while 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 (%TBWL) after 3 years of follow-up (LT cohort 3.9±13.3% vs. LT+SG 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 anti-hypertensive medications and lipid agents at last follow-up. Conclusion: While 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. This article is protected by copyright. All rights reserved.

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