Division of General Surgery, McMaster University, Hamilton, Ontario, Canada; Centre for Minimal Access Surgery (CMAS), St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Surg Obes Relat Dis. 2020 Sep;16(9):1336-1347. doi: 10.1016/j.soard.2020.05.012. Epub 2020 May 25.
Morbid obesity is considered a relative contraindication for liver transplantation (LTX) because of increased risk of complications. The aim of this study was to investigate the role of bariatric surgery before, during, and after LTX. A systematic review of MEDLINE, EMBASE, CENTRAL, and PubMed databases was performed for studies investigating bariatric surgery in patients before, during, or after LTX. Random-effects meta-analysis of proportions was used to calculate pooled effect estimates. One hundred eighty-seven patients underwent bariatric surgery before LTX (8 studies). After surgery, 82% (95% confidence interval, 62%-97%) of patients were successfully listed for LTX and 70% (95% confidence interval, 40%-93%) successfully received LTX. The 30-day mortality rate was 0%. The graft survival rate after 1 year was 70% (95% confidence interval, 30%-99%). Thirty-day minor and major complications rate was 4% and 1%, respectively. Thirty-two patients underwent bariatric surgery during LTX (2 studies). The 30-day mortality rate after surgery was 0% and 1-year graft survival was 100%. Sixty-four patients underwent bariatric surgery after LTX (9 studies). The 30-day mortality was 0%, but 5 deaths occurred beyond 30 days (7.8%). Bariatric surgery may be safe and feasible as a bridge to LTX for patients who would otherwise be ineligible and post-LTX patients for weight loss.
病态肥胖被认为是肝移植 (LTX) 的相对禁忌症，因为其并发症风险增加。本研究旨在探讨在 LTX 之前、期间和之后进行减肥手术的作用。对 MEDLINE、EMBASE、CENTRAL 和 PubMed 数据库进行了系统回顾，以调查在 LTX 之前、期间或之后对患者进行减肥手术的研究。使用比例的随机效应荟萃分析来计算汇总效应估计值。187 名患者在 LTX 前接受了减肥手术（8 项研究）。手术后，82%（95%置信区间，62%-97%）的患者成功被列入 LTX 名单，70%（95%置信区间，40%-93%）的患者成功接受了 LTX。30 天死亡率为 0%。1 年后的移植物存活率为 70%（95%置信区间，30%-99%）。30 天轻微和主要并发症发生率分别为 4%和 1%。32 名患者在 LTX 期间接受了减肥手术（2 项研究）。手术后 30 天的死亡率为 0%，1 年的移植物存活率为 100%。64 名患者在 LTX 后接受了减肥手术（9 项研究）。30 天死亡率为 0%，但 5 例死亡发生在 30 天之后（7.8%）。减肥手术可为不适合 LTX 的患者和 LTX 后的患者提供减肥作为桥接手段，可能是安全且可行的。
