5 years ago

Outcome of liver transplantation in patients with prior bariatric surgery.

Salgia R, Safwan M, Abouljoud MS, Collins KM
Non-alcoholic fatty liver disease is becoming the leading cause of disease resulting in liver transplantation (LT). As a result of this trend, more liver transplant candidates are presenting with prior history of bariatric surgery (BS). Over the last decade, 960 patients underwent LT at our institution; 11 (1.1%) had prior BS. Most common type of BS was Roux-en-Y gastric bypass (n=9) with 1 sleeve gastrectomy and 1 jejunoileal bypass. Nine patients underwent LT alone and 2 underwent simultaneous liver-kidney transplantation. Most common indication for LT was non-alcoholic steatohepatitis (n=10) with 5 having additional diagnosis of alcoholic liver disease. Thirty-day reoperation rate was 36.4% (n=4); indications were bile duct repair (n=3) and wound repair (n=1). In first 6 months after LT, biliary complications were seen in 54.5% (n=6) of the patients. Both patient and graft survival rates at 1 and 2 years were 81.8% (n=9) and 72.7% (n=8), respectively. Eight patients (72.7%) had indications for liver biopsy post-LT; significant macro-vesicular steatosis was found in 2 (18.2%). In patients with history of alcohol consumption, 2 (40.0%) relapsed post-LT. Two patients (18.2%) had history of diet-controlled diabetes pre-LT; 1 of these patients became insulin dependent post-LT. Mean body mass index at LT was 31.0±5.7. Mean body mass index at 1, 6, and 12 months post LT was 28.3±5.8, 28.0±3.2 and 31.0±6.6, respectively. Mean preoperative albumin was 2.6±0.6 mg/dl. Patients showed improvement in albumin post-LT, with mean albumin of 2.7±0.6 and 3.2±0.5 mg/dl, at 1 and 3 months, respectively. Liver profile was stable post-LT, with mean AST of 32.9±18.4 and 26.6±19.8 IU/L and ALT of 28.0±17.5 and 30.2±17.0 IU/L at 6 and 12 months, respectively. In conclusion, outcomes of LT patients with prior BS are comparable to other transplant recipients with regards to patient and graft survival, and post-LT complication rates. This article is protected by copyright. All rights reserved.

Publisher URL: https://www.ncbi.nlm.nih.gov/pubmed/28752920

DOI: PubMed:28752920

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