William J von Liebig Transplant Center.
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.
肥胖在肝移植(LT)前后越来越常见,但最佳管理仍不清楚。我们的目的是分析需要 LT 的肥胖患者的多学科方案的有效性,包括非侵入性的移植前减肥计划,以及对移植前未能减肥的肥胖患者进行 LT 加袖状胃切除术(SG)的联合治疗。自 2006 年以来,所有 BMI>35 的 LT 转介患者均被纳入研究。其中有 37 名患者减肥成功并单独接受 LT,7 名患者接受 LT 联合 SG。在单独接受 LT 的患者中,21/34 名患者 BMI>35 体重增加,12/34 名患者发生 LT 后糖尿病(DM),7/34 名患者发生脂肪变性,3 例死亡加 3 例移植物丢失。在接受联合手术的患者中,没有死亡或移植物丢失。一名患者发生胃钉线渗漏,一名患者发生体重过度减轻。没有患者发生 LT 后 DM 或脂肪变性,所有患者均显著减轻体重(平均 BMI=29)。大多数患者通过非侵入性的移植前减肥达到了减肥目标,但 LT 后体重增加是常见的。LT 加 SG 的联合治疗可有效减轻体重,并与较少的 LT 后代谢并发症相关。需要进行长期随访。