Liver transplantation, sleeve gastrectomy maintain weight loss, reduce metabolic complications
A combination of liver transplant and sleeve gastrectomy helps obese patients maintain their weight loss while having fewer metabolic complications, a US study shows.
The study involved 49 adults with a body mass index (BMI) of >35 kg/m2 who were referred to Mayo Clinic for a liver transplant since 2006. Of those, 36 lost enough weight, achieved a BMI of <35 kg/m2 and underwent a liver transplant alone. However, 29 patients could not lose sufficient weight prior to transplant and had to undergo a combined liver transplant and sleeve gastrectomy, with 13 of them being at least 3 years or more from the time of the surgery. During sleeve gastrectomy, the size of the stomach is reduced by about 80 percent with the intention to induce weight loss. [Hepatology2018;68(2):485–495]
Although patients who underwent the liver transplant alone had significant weight loss before surgery, they steadily gained weight afterwards. The percentage of total body weight gained ended up being higher among those patients who had the liver transplant alone compared to those who underwent both a liver transplant and sleeve gastrectomy. Three years after surgery, patients who had the liver transplant alone maintained a weight loss of a median of 3.9 percent of their total body weight compared to 34.8 percent for patients who had the transplant and sleeve gastrectomy. In addition, those patients who had the dual surgery were less likely to have high blood pressure, insulin resistance and fatty liver. They needed less medication to lower blood pressure and cholesterol.
Three years posttransplant, almost 30 percent of patients who underwent the liver transplant alone maintained >10 percent loss in total body weight. In contrast, all of those who underwent both a liver transplant and sleeve gastrectomy maintained a weight loss of >10 percent (p<0.001). After 3 years of follow-up, patients who underwent liver transplant and sleeve gastrectomy maintained a significantly higher percentage of total body weight loss (p<0.001). They also had a lower prevalence of hypertension, insulin resistance and hepatic steatosis and required fewer antihypertensive medications and lipid agents at last follow-up.
“This study shows that the combined approach of liver transplantation and weight-loss surgery is safe and effective over the long term,” said senior author Dr Julie K. Heimbach, a transplant surgeon and division chair of Transplant Surgery at Mayo Clinic, Rochester, Minnesota, US.
“Obesity-related liver disease is one of the most common and rapidly increasing reasons that people need a liver transplant. Even though most obese people will not need a transplant, for those who develop advanced liver disease, we need to have an approach that treats not only the liver disease but the cause of the liver disease.”
Obesity rates in the US as well as the number of people diagnosed with nonalcoholic fatty liver disease have increased. An estimated 80 to 100 million Americans have been diagnosed with this chronic liver disease. Severely obese patients have had to forgo liver transplant because of their inability to lose sufficient weight. Being obese can increase their surgical risks and is a potential risk factor for post- transplant complications.