[en] [en] BACKGROUND: Weight gain poses a rising concern post-liver transplantation (LT), and metabolic dysfunction-associated steatotic liver disease (MASLD) might impair graft health. The timing is crucial when considering bariatric surgery (BS) in a population with liver disease or transplantation. BS can be considered for post-LT weight gain, although the evidence is limited and the long-term outcome still uncertain.
METHODS: We conducted a national retrospective analysis in 5 Belgian transplant centres and included 25 patients with a liver transplantation followed by a bariatric procedure. 187 LT patients without BS were included for comparison. Clinical, biochemical and outcome data were retrospectively retrieved.
RESULTS: In our nationwide cohort, 25 patients had undergone BS post-LT, at a median 3.5 years after LT. Twenty-one (84.0%) patients received a sleeve gastrectomy (SG). Patients were predominantly male (72.0%), with a lower age at time of transplantation compared to non-BS population (54.5 vs. 60.6, p<0.001). Weight loss was significant and sustained, with a decrease in BMI from 41.0±4.5 pre-BS to 32.6±5.8 1-3 years post-BS (p<0.001) and 31.1±5.8 3-5 years post-BS (p<0.001). Post-LT pre-BS three (12.0%) patients presented with recurrent and one (4.0%) de novo MASLD, with 100% resolution post-BS (p=0.016). Notable reductions were observed in ALT levels (40.5±28.5 U/L to 27.1±25.1 U/L post-BS, p=0.05) and HbA1c levels (6.9±1.6 to 6.0±1.4 post-BS, p<0.001). Three patients were re-transplanted, and eight patients died, of which five (20.0%) due to a non-hepatic malignancy and one (4.0%) due to liver failure.
CONCLUSIONS: SG is the favored BS post-LT and has proven to be safe and feasible in a post-LT setting with favorable metabolic consequences. SG post-LT is a valid treatment for de novo and recurrent MASLD post-LT. Although we report on the largest cohort to date, there is still a need for larger cohorts to examine the effect of BS on patient and graft survival.
Disciplines :
Surgery Gastroenterology & hepatology
Author, co-author :
Onghena, Louis ; Department for Human Structure and Repair, Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium ; Department for Human Structure and Repair, Department of General and Hepatobiliary Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium ; Department of Internal Medicine and Pediatrics, Hepatology Research Unit, Ghent University, Ghent, Belgium ; Liver Research Center Ghent, Ghent University, Ghent University Hospital, Ghent, Belgium
Geerts, Anja ; Department of Internal Medicine and Pediatrics, Hepatology Research Unit, Ghent University, Ghent, Belgium ; Liver Research Center Ghent, Ghent University, Ghent University Hospital, Ghent, Belgium
Berrevoet, Frederik ; Department for Human Structure and Repair, Department of General and Hepatobiliary Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
Pirenne, Jacques; Department for Abdominal Transplant Surgery and Coordination, University Hospitals Leuven, Leuven, Belgium
Verbeek, Jef ; Department of Gastroenterology & Hepatology, University Hospitals Leuven, Leuven, Belgium
Bonaccorsi-Riani, Eliano; Abdominal Transplant Unit, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium ; Pôle de Chirurgie Expérimentale et Transplantation, Institute de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
Dahlqvist, Geraldine; Department of Hepatogastroenterology and Liver Transplantation, University Hospitals Saint-Luc, Brussels, Belgium
Vonghia, Luisa; Division of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerp, Belgium
Detry, Olivier ; Université de Liège - ULiège > Département des sciences cliniques > Pathologie chirurgicale abdominale et endocrinienne
Delwaide, Jean ; Université de Liège - ULiège > Département des sciences cliniques
Lefere, Sander ; Department of Internal Medicine and Pediatrics, Hepatology Research Unit, Ghent University, Ghent, Belgium ; Liver Research Center Ghent, Ghent University, Ghent University Hospital, Ghent, Belgium
van Nieuwenhove, Yves ; Department for Human Structure and Repair, Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium
Language :
English
Title :
Bariatric surgery post-Liver Transplantation: A Belgian nationwide study.
Publication date :
01 April 2024
Journal title :
Liver Transplantation
ISSN :
1527-6465
eISSN :
1527-6473
Publisher :
Ovid Technologies (Wolters Kluwer Health), United States
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