Kumar Suneed, Khandelwal Nidhi, Kumar Abhaya, Yadav Kapildev, Sharma Swapnil, Sable Shailesh, Chauhan Ashutosh, Kapoor Sorabh, Varma Vibha, Palep Jaydeep, Kumaran Vinay
Department of HPB and Liver Transplant, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Achutrao Patwardhan Marg, Mumbai, 400 053, India.
Department of Metabolic and Bariatric Surgery, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Achutrao Patwardhan Marg, Mumbai, 400 053, India.
Indian J Gastroenterol. 2017 May;36(3):243-247. doi: 10.1007/s12664-017-0753-5. Epub 2017 May 31.
Nonalcoholic steatohepatitis (NASH) with morbid obesity and metabolic syndrome is now a common cause of end-stage liver disease (ESLD). These patients are high-risk candidates for liver transplant, and require bariatric surgery to prevent recurrent disease in the new liver. Data reports bariatric surgery after transplant, which maybe difficult because of adhesions between the stomach and liver in living donor liver transplant (LDLT) recipient. We report the first case of combined LDLT with sleeve gastrectomy (SG) from India. A morbidly obese diabetic woman with NASH-related ESLD was planned for combined right lobe LDLT with open SG, in view of failed diet therapy, musculo-skeletal complaints, and restricted mobility. Postoperatively, with liver graft functioning adequately, bariatric diet restrictions resulted in maximum reduction of 25% weight, achieving a target BMI below 30 kg/m within 2 months, along with complete cure of diabetes and better ambulation. Thus, combination of LDLT and bariatric surgery in the same sitting is safe and effective in management of metabolic syndrome and associated NASH-related ESLD.
伴有病态肥胖和代谢综合征的非酒精性脂肪性肝炎（NASH）如今是终末期肝病（ESLD）的常见病因。这些患者是肝移植的高危候选者，并且需要进行减肥手术以防止新肝脏中疾病复发。有数据报道了移植后进行减肥手术的情况，这在活体供肝肝移植（LDLT）受者中可能会很困难，因为胃和肝脏之间存在粘连。我们报告了印度首例联合LDLT与袖状胃切除术（SG）的病例。一名患有NASH相关ESLD的病态肥胖糖尿病女性，鉴于饮食治疗失败、肌肉骨骼问题和行动受限，计划进行右叶LDLT联合开放式SG。术后，肝脏移植物功能良好，减肥饮食限制使体重最大减轻了25%，在2个月内达到了目标BMI低于30kg/m²，同时糖尿病完全治愈且行动能力得到改善。因此，在同一手术中联合LDLT和减肥手术在治疗代谢综合征及相关的NASH相关ESLD方面是安全有效的。
