Division of Surgery, Assuta University Medical Center Ashdod, Ashdod, Israel.
Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Clin Transplant. 2021 Aug;35(8):e14374. doi: 10.1111/ctr.14374. Epub 2021 Jun 13.
The increasing prevalence of morbid obesity (MO) results in parallel growth of obesity-associated liver diseases necessitating liver transplantation (LT).
To examine the feasibility and safety of Roux-en-Y gastric bypass or sleeve gastrectomy in the setting of LT.
This retrospective chart review included the data on all the MO candidates before and after LT who underwent bariatric surgery (BS) in our institution between 04/2013-09/2016. The reported outcomes were weight change and early and late postoperative complications (mean follow-up: 43 ± 11.1 months).
Eighteen MO peri-LT patients (10 females, 8 males, average age 48 years) were included in the study. Ten had cirrhosis (mean Model of End-stage Liver Disease [MELD] score of 12.5 ± 6.42), three underwent concurrent LT and BS (mean MELD score 23.7 ± 0.58), and five had LT (mean of 56 months from LT). The mean percentage of total and excess weight loss was 31% and 81%, respectively. Six of the eight patients with type 2 diabetes mellitus became normoglycemic after BS. Three patients sustained perioperative complications. Two cirrhotic patients died 1 and 4.5 years after BS with decompensation.
Bariatric surgery appears to effectively address obesity in cirrhotic and LT patients. The surgical risk is higher than that of the regular BS population.
病态肥胖症（MO）的患病率不断增加，导致与肥胖相关的肝脏疾病也相应增加，这使得肝移植（LT）的需求也在不断增长。
探讨 Roux-en-Y 胃旁路术或袖状胃切除术在 LT 中的可行性和安全性。
本回顾性图表研究纳入了 2013 年 4 月至 2016 年 9 月期间在我院接受过减重手术（BS）的所有 MO 候选者在 LT 前后的数据。报告的结果是体重变化以及早期和晚期术后并发症（平均随访时间：43±11.1 个月）。
本研究纳入了 18 例 MO 围 LT 患者（10 名女性，8 名男性，平均年龄 48 岁）。其中 10 例患有肝硬化（平均终末期肝病模型评分[MELD]为 12.5±6.42），3 例同时接受 LT 和 BS（平均 MELD 评分为 23.7±0.58），5 例接受 LT（LT 后平均 56 个月）。总体重减轻和多余体重减轻的平均百分比分别为 31%和 81%。6 例 2 型糖尿病患者在 BS 后血糖恢复正常。有 3 例患者发生围手术期并发症。2 例肝硬化患者在 BS 后 1 年和 4.5 年后因肝功能失代偿死亡。
BS 似乎可以有效地解决肝硬化和 LT 患者的肥胖问题。手术风险高于常规 BS 人群。
