Clinical Impact of Antecedent Bariatric Surgery on Liver Transplant Outcomes: A Retrospective Matched Case-control Study

Abstract

Original Clinical Science-Liver Background. Bariatric surgery (BS) may be associated with significant malabsorption and nutritional deficiencies. Methods. Between March 1987 and January 2017, we performed 922 liver transplants (LT) at our institution; 33 had antecedent BS. We matched the BS cohort to LT recipients without BS (1:3 matching) based on exact matching for gender and cancer and inverse variance matching for age, LT body mass index, MELD score, and transplant date. Results. We analyzed outcomes in 132 LT recipients (33 BS; 99 non-BS). The BS cohort comprised 26 (79%) women with a mean age of 52.4 years. The BS procedures included 20 Roux-en-Y gastric bypass (61%), 6 jejunoileal bypass (18%), 3 gastric band (9%), 2 sleeve gastrectomy (6%), and 1 duodenal switch (3%). The primary indications for LT listing were alcoholic cirrhosis (9; 27%), nonalcoholic steatohepatitis (7; 21%), hepatitis C (8; 24%), and hepatocellular carcinoma (3; 9%). At LT, body mass index for the BS cohort was 29.6, and MELD was 24. Compared with matched controls, BS recipients did not have longer LT length of hospital stay (17.8 versus 15.7 d, P = 0.71), longer intensive care unit length of stay (5.3 versus 4.1 d, P = 0.16), or higher 30-day complication rate (76% versus 85%, P = 0.43). Overall patient survival was similar (1-and 3-y survival was 90.1% and 75.9% for BS; 90.9% and 76.4% for non-BS, P = 0.34). Conclusions. A history of BS does not portend a deleterious effect on LT outcomes.

Bariatric Surgery in the Peritransplant Period

“…In the study by Idriss et al, 43 although patients with a history of BS were more likely to be listed for transplant than their matched counterparts, the authors found a higher rate of delisting or death on the wait list, attributed to complication from their BS. However, in both studies, RYGB was the most commonly performed procedure, as well as the most likely to have post‐LT complications 42,43 …”

“…[36][37][38][39][40][41] In two retrospective matched cohort studies, patients with a history of bariatric surgery who underwent LT had no difference in hospital length of stay, complication rate, rejection rate, or 1-and 3-year survival compared with patients who underwent LT alone. 42,43 In the study by Idriss et al, 43 although patients with a history of BS were more likely to be listed for transplant than their matched counterparts, the authors found a higher rate of delisting or death on the wait list, attributed to complication from their BS. However, in both studies, RYGB was the most commonly performed procedure, as well as the most likely to have post-LT complications.…”

“…The majority of patients had mild portal hypertension or were classified as Child‐Pugh class A, and those with increased complications, including superficial wound infections, encephalopathy, acute kidney injury, and bleeding typically occurred in patients with higher Model for End‐Stage Liver Disease (MELD) scores >11 36‐41 . In two retrospective matched cohort studies, patients with a history of bariatric surgery who underwent LT had no difference in hospital length of stay, complication rate, rejection rate, or 1‐ and 3‐year survival compared with patients who underwent LT alone 42,43 . In the study by Idriss et al, 43 although patients with a history of BS were more likely to be listed for transplant than their matched counterparts, the authors found a higher rate of delisting or death on the wait list, attributed to complication from their BS.…”

“…However, in both studies, RYGB was the most commonly performed procedure, as well as the most likely to have post-LT complications. 42,43 Zamora-Valdes et al 44 provided updates and long-term outcomes to an earlier experience published in Heimbach et al 45 of combined liver transplant (LT) with concurrent SG in obese patients who did not lose weight prior to LT. Patients who underwent simultaneous LT and SG had higher biological MELD scores than those undergoing LT alone.…”

Clinical and Economic Impact of Previous Bariatric Surgery on Liver Transplantation: a Nationwide, Population-Based Retrospective Study

“…A few monocentric series have reported the results of LT in patients with a history of BS, including a small number of patients in each study [7,[15][16][17][18]. The majority of single-center studies did not find significant differences in the outcomes of LT between patients with or without history of BS [7,15,18].…”