Combined liver transplantation and gastric sleeve resection for patients with medically complicated obesity and end-stage liver disease

Am J Transplant. 2013 Feb;13(2):363-8. doi: 10.1111/j.1600-6143.2012.04318.x. Epub 2012 Nov 8.


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.

MeSH terms

  • Adult
  • Aged
  • Body Mass Index
  • Endoscopy / methods
  • Female
  • Gastrectomy / methods
  • Gastric Bypass / methods*
  • Humans
  • Liver Failure / complications
  • Liver Failure / therapy*
  • Liver Transplantation / methods*
  • Male
  • Middle Aged
  • Obesity / complications
  • Obesity / surgery*
  • Risk Factors
  • Treatment Outcome
  • Weight Loss