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Outcomes of Sleeve Gastrectomy in Obese Liver Transplant Candidates
Author(s) -
Sharpton Suzanne R.,
Terrault Norah A.,
Posselt Andrew M.
Publication year - 2019
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.25406
Subject(s) - medicine , sleeve gastrectomy , contraindication , interquartile range , liver transplantation , perioperative , liver disease , body mass index , weight loss , surgery , cohort , decompensation , obesity , cirrhosis , transplantation , gastroenterology , gastric bypass , alternative medicine , pathology
Morbid obesity (body mass index [BMI] ≥40 kg/m 2 ) is a relative contraindication to liver transplantation (LT) at many transplant centers. The safety and efficacy of pre‐LT bariatric surgery in morbidly obese LT candidates is unknown. Herein, we describe a cohort study of morbidly obese LT candidates who failed to achieve adequate weight loss through a medically supervised weight loss program and subsequently underwent sleeve gastrectomy (SG) at our institution. In total, 32 LT candidates with a median Model for End‐Stage Liver Disease (MELD) score of 12 (interquartile range [IQR], 10‐13) underwent SG. All LT candidates had a history of hepatic decompensation, but complications of liver disease were required to be well controlled at the time of SG. Median pre‐SG BMI was 45.0 kg/m 2 (IQR, 42.1‐49.0 kg/m 2 ). There were no perioperative deaths or liver‐related morbidity. One patient experienced major perioperative morbidity secondary to a gastric leak, which was managed nonoperatively. Median weight loss at 6 and 12 months after SG was 22.0 kg (IQR, 18.9‐26.8 kg) and 31.0 kg (IQR, 23.6‐50.3 kg), respectively, corresponding to a percentage of excess body weight lost of 33.4% and 52.4%. Within 6 months after SG, 28 (88%) candidates were deemed eligible for LT. Our center’s experience highlights the potential option of SG in morbidly obese LT candidates with advanced liver disease who might otherwise be excluded from pursuing LT.