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

Gentileschi, Paolo; Venza, Marco; Benavoli, Domenico; Lirosi, Francesca; Camperchioli, Ida; D’Eletto, Marco; Lazzaro, Alessandra; Stolfi, Vito M.; Anselmo, Alessandro; Lorenzo, Nicola Di; Tisone, Giuseppe; Gaspari, Achille

doi:10.1007/s11695-009-9877-8

Cited by 21 publications

(11 citation statements)

References 20 publications

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“…Bariatric surgery performed between 6 months and 10 years after LT has been described in case reports (14)(15)(16)(17). All of these reported cases have had minimal complications and patient outcomes appear satisfactory but with limited follow-up detail.…”

Section: Discussionmentioning

confidence: 99%

“…Bariatric surgery may be suitable for patients with early-stage liver disease (11), but it is not indicated for patients with decompensated liver disease (12). Posttransplant bariatric surgery may be an option though requires two separate major operations and may be associated with increased technical difficulty due to adhesions and complications related to long-term immunosuppression (13)(14)(15)(16).…”

Section: Introductionmentioning

confidence: 99%

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Combined Liver Transplantation and Gastric Sleeve Resection for Patients With Medically Complicated Obesity and End-Stage Liver Disease

Heimbach

Watt

Poterucha

et al. 2013

American Journal of Transplantation

232

159

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Obesity is increasingly common before and after liver transplantation (LT), yet optimal management remains unclear. Our aim was to analyze the effectiveness of a multidisciplinary protocol for obese patients requiring LT, including a noninvasive pretransplant weight loss program, and a combined LT plus sleeve gastrectomy (SG) for obese patients who failed to lose weight prior to LT. Since 2006, all patients referred LT with a BMI > 35 were enrolled. There were 37 patients who achieved weight loss and underwent LT alone, and 7 who underwent LT combined with SG. In those who received LT alone, weight gain to BMI > 35 was seen in 21/34, post-LT diabetes (DM) in 12/34, steatosis in 7/34, with 3 deaths plus 3 grafts losses. In patients undergoing the combined procedure, there were no deaths or graft losses. One patient developed a leak from the gastric staple line, and one had excess weight loss. No patients developed post-LT DM or steatosis, and all had substantial weight loss (mean BMI = 29). Noninvasive pretransplant weight loss was achieved by a majority, though weight gain post-LT was common. Combined LT plus SG resulted in effective weight loss and was associated with fewer post-LT metabolic complications. Long-term follow-up is needed.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Combined Liver Transplantation and Gastric Sleeve Resection for Patients With Medically Complicated Obesity and End-Stage Liver Disease

Heimbach

Watt

Poterucha

et al. 2013

American Journal of Transplantation

232

159

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“…These findings are comparable to %EWL seen in the nontransplant population that range from 53.3% in LSG and 62.6% in RYGB . In the post‐LT population, %EWL ranges from 43% to 76% in studies with a minimum of 12‐month follow‐up . In a recent series of 12 patients who underwent LSG following LT, Tsamalaidze et al demonstrated a change in BMI similar to a matched non‐LT cohort and a %EWL of 50% at 1 year .…”

Section: Discussionmentioning

confidence: 52%

Delayed Sleeve Gastrectomy Following Liver Transplantation: A 5‐Year Experience

et al. 2019

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Obesity has become an epidemic in the United States over the past decade, and recent studies have shown this trend in the liver transplantation (LT) population. These patients may be candidates for laparoscopic sleeve gastrectomy (LSG) to promote significant and sustained weight loss to prevent recurrence of nonalcoholic steatohepatitis. However, safety remains a concern, and efficacy in this setting is uncertain. A single‐institution database from 2014 to 2018 was queried for patients undergoing LSG following LT. The selection criteria for surgery were consistent with National Institutes of Health guidelines, and patients were at least 6 months after LT. A total of 15 patients (median age, 59.0 years; Caucasian, 86.7%; and female, 60%) underwent LSG following LT. Median time from LT to LSG was 2.2 years with a median follow‐up period of 2.6 years. The median hospital length of stay (LOS) was 2 days after LSG. Mortality and rate of liver allograft rejection was 0, and there was 1 postoperative complication (a surgical site infection). Following LSG, body mass index (BMI) decreased from 42.7 to 35.9 kg/m2 (P < 0.01), and in 12 patients with at least 1 year of follow‐up, the total body weight loss was 20.6%. Following LSG in patients with diabetes, the median daily insulin requirements decreased from 98 (49‐118) to 0 (0‐29) units/day (P = 0.02), and 60% discontinued insulin. Post‐LT patients had a similar decrease in BMI and reduction in comorbidities at 1 year compared with a matched non‐LT patient cohort. In the largest patient series to date, we show that LSG following LT is safe, effective, and does not increase the incidence of liver allograft rejection. Larger longer‐term studies are needed to confirm underlying metabolic changes following LSG.

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“…Managing weight gain after transplantation is equally fraught with difficulties. Case reports of bariatric surgery performed 6 months to 10 years after LT exist 11‐14. All these reported cases have had minimal complications, and the patient outcomes were good during the limited follow‐up reported.…”

Section: Obesitymentioning

confidence: 99%

Obesity and metabolic complications of liver transplantation

Watt¹

2010

Liver Transpl

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Foundation, Rochester, MNKey Points 1. The body mass index is not an adequate measure of obesity in patients with cirrhosis. It is necessary to account for the contributions of ascites and fluid overload in addition to the distribution of adipose tissue. The interpretation of the literature on the effects of the body mass index on posttransplant outcomes is difficult if adjustments are not made for these factors. 2. Survival after liver transplantation has improved over the years and appears unaffected by obesity (even class III obesity) before transplantation. 3. Obesity is even more common after liver transplantation. Weight increases occur, with the greatest gains occurring within the first 6 months of transplant. Education and lifestyle management for the prevention of weight gain are the first measures in the posttransplant management of obesity. 4. Further investigation of bariatric surgery before, during, and after transplantation is needed. 5. Metabolic syndrome and its individual components are common after liver transplantation and are associated with increased risks of cardiovascular disease, cardiovascular death, liver-related deaths, and overall mortality. 6. Recurrent or de novo steatosis in the allograft is not uncommon and is a risk for steatohepatitis and progression to cirrhosis with graft loss. Liver Transpl 16:S65-S71, All aspects of liver transplantation (LT)-pretransplant, perioperative, and posttransplant-are affected by obesity and metabolic syndrome. Both obesity and metabolic syndrome are extremely prevalent in the general population and thus in transplant patients. Nonalcoholic fatty liver disease, a manifestation of metabolic syndrome, is an increasingly common indication for LT, but obesity is also commonly noted in many other patients with underlying chronic liver disease.This discussion concerns the clinical relevance of obesity and metabolic syndrome specifically with respect to LT and is not meant to be a thorough review of the literature. OBESITYObesity is categorized according to the body mass index (BMI): overweight, BMI ¼ 25-29.9 kg/m 2 ; class I obesity, BMI ¼ 30-34.9 kg/m 2 ; class II obesity, BMI ¼ 35-39.9 kg/m 2 ; and class III obesity, BMI 40 kg/ m 2 . BMI, however, is not an accurate measure of true body fat versus lean muscle mass, for which waist circumference measures may better account. Central adipose tissue, typically manifesting as increased abdominal girth, is more metabolically active than peripheral adipose tissue and confers a greater risk factor for metabolic syndrome and cardiovascular disease (CVD). In our patient population (patients with end-stage cirrhosis), even waist circumference

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

Cited by 21 publications

References 20 publications

Combined Liver Transplantation and Gastric Sleeve Resection for Patients With Medically Complicated Obesity and End-Stage Liver Disease

Combined Liver Transplantation and Gastric Sleeve Resection for Patients With Medically Complicated Obesity and End-Stage Liver Disease

Delayed Sleeve Gastrectomy Following Liver Transplantation: A 5‐Year Experience

Obesity and metabolic complications of liver transplantation

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