Low Molecular Weight Heparin in Liver Transplant Recipients After Sleeve Gastrectomy

Iannelli, Antonio; Petrucciani, Niccolò

doi:10.1002/lt.26086

Cited by 2 publications

(2 citation statements)

References 6 publications

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“…If patients are candidates for a liver transplantation and MBS is intended as a preparation for liver transplantation it should be considered that portal thrombosis may further complicate the access to transplantation and MBS should be better performed at the time of or after liver transplantation 28 . If no liver transplant is hypothesized, and the SG is chosen, then the anticoagulation should be adapted to this increased risk 29 , 30 . Furthermore, Pais et al .…”

Section: Discussionmentioning

confidence: 99%

Outcomes of bariatric surgery in the setting of compensated advanced chronic liver disease associated with clinically significant portal hypertension: a multicenter, retrospective, cohort study on feasibility and safety

Temime,

Ghanem,

Heimbach

et al. 2024

International Journal of Surgery

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Background: The obesity epidemic has led to an increase in the proportion of patients with chronic liver disease due to metabolic associated steatosic liver disease and in the prevalence of obesity in patients with cirrhosis. Metabolic and bariatric surgery has been proven to determine weight loss, obesity-related medical problems remission, and liver steatosis, inflammation, and fibrosis improvement. However, cirrhosis and portal hypertension are well-known risk factors for increased morbidity and mortality after surgery. The aim of this study is to evaluate the safety of metabolic and bariatric surgery in patients with compensated advanced chronic liver disease and clinically significant portal hypertension. Material and Methods: This is an international, multicentric, retrospective study on 63 individuals affected by obesity with compensated advanced chronic liver disease and clinically significant portal hypertension who underwent metabolic and bariatric surgery in tertiary referral centers with experts hepatobiliary surgeons between January 2010 and October 2022. The primary endpoint was post-operative mortality at 90 days. The secondary endpoints included postoperative weight loss at last follow-up and postoperative complication rate. In addition, we performed subgroup analyses of Child-Pugh (A vs. B) score, MELD (≤9 vs. >9) score and type of surgery. Results: One patient (1.6%) experienced gastric leakage and mortality. There were 3 (5%) reported cases of portal vein thrombosis, 2 (3%) postoperative acute renal failure, and 1 (1.6%) postoperative encephalopathy. Child-Pugh score A resulted to be a protective factor for intraoperative bleeding requiring transfusion at univariate analysis ((OR: 0.73, 95% CI: 0.55 – 0.97, P=0.046) but not at multivariate analysis. MELD>9 score and the type of surgery did not result to be a risk factor for any postoperative complication. Conclusion: Metabolic and bariatric surgery is safe in patients with compensated advanced chronic liver disease and clinically significant portal hypertension performed in tertiary bariatric referral centers with hepatobiliary expert surgeons. Larger, prospective studies with longer follow-up periods are needed to confirm these results.

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Section: Discussionmentioning

confidence: 99%

Outcomes of bariatric surgery in the setting of compensated advanced chronic liver disease associated with clinically significant portal hypertension: a multicenter, retrospective, cohort study on feasibility and safety

Temime,

Ghanem,

Heimbach

et al. 2024

International Journal of Surgery

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“…There is increasing literature to support simultaneous bariatric surgery and LT among selected candidates. Simultaneous bariatric surgery and LT is a potential solution for those with decompensated liver disease who cannot receive antecedent bariatric surgery and fail pre-LT medical obesity management strategies [ 106 , 116 , 117 , 118 , 119 , 120 , 121 , 122 , 123 ]. SG is preferred over RYGB as the anatomy allows endoscopic biliary access and it is associated with lower risk of leak complications and malnutrition.…”

Section: Simultaneous Bariatric Surgery and Liver Transplantationmentioning

confidence: 99%

The Impact of Metabolic Health and Obesity on Liver Transplant Candidates and Recipients

Vogel,

Roediger,

von Ahrens

et al. 2024

Life

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Poor metabolic health and obesity have significant impacts on the outcomes of patients suffering from chronic liver disease, particularly those with metabolic dysfunction-associated steatotic liver disease. Patients with such comorbidities who require liver transplant evaluation for advancing liver disease or liver failure require special consideration due to increased risk of cardiovascular disease, renal dysfunction, sarcopenic obesity, and cancer. Those who have had a history of prior bariatric surgery pose specific anatomical constraints and may also be at increased risk of alcohol use disorder. Pre-operative risk assessment as well as strict control of metabolic risk factors are essential to reduce intra-operative and post-liver transplant complications. As immunosuppressive therapy exacerbates metabolic dysfunction and risk for cancer, post-liver transplant care must focus on balancing the need to prevent rejection and the impact of progressive metabolic dysfunction in this unique, but growing, patient population.

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Low Molecular Weight Heparin in Liver Transplant Recipients After Sleeve Gastrectomy

Cited by 2 publications

References 6 publications

Outcomes of bariatric surgery in the setting of compensated advanced chronic liver disease associated with clinically significant portal hypertension: a multicenter, retrospective, cohort study on feasibility and safety

Outcomes of bariatric surgery in the setting of compensated advanced chronic liver disease associated with clinically significant portal hypertension: a multicenter, retrospective, cohort study on feasibility and safety

The Impact of Metabolic Health and Obesity on Liver Transplant Candidates and Recipients

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