Anselmo Alessandro, Siragusa Leandro, Sensi Bruno, Bacchiocchi Giulia, Pellicciaro Marco, Manzia Tommaso Maria, Gentileschi Paolo, Tisone Giuseppe
Department of Surgery, University of Rome Tor Vergata, Rome, Italy.
Department of Surgery, University of Rome Tor Vergata, Rome, Italy.
Obes Res Clin Pract. 2022 Jan-Feb;16(1):91-94. doi: 10.1016/j.orcp.2022.01.001. Epub 2022 Jan 10.
Morbid obesity is a worldwide epidemic closely linked to Non-Alcoholic Fatty Liver Disease (NAFLD), an ever more relevant indication for Liver Transplantation (LT). Obesity affects an increasing number of LT recipients, but the ideal management of these patients remain unclear. Bariatric surgery (BS) in LT setting is challenging but feasible, although the debate is still open about the best timing of bariatric surgery. Herein we report a case of high-priority LT and simultaneous sleeve gastrectomy (SG) in an obese young adult.
A 45 years old man with morbid obesity (BMI 46 kg/m) and severe NAFLD-related end-stage liver disease (ESLD) underwent simultaneous LT and sleeve gastrectomy (SG) in an emergency setting, due to a MELD score of 32. He had substantial weight loss during long-term follow-up and enjoyed resolution of diabetes and hypertension. At 4 years follow-up, he has normal allograft function with appropriate immunosuppressant blood levels and no ultrasound evidence of steatosis.
In selected patients, combined LT and SG present several advantages in terms of transplant outcomes, weight loss and resolution of obesity-related comorbidities. In addition, it can be performed in the high-priority setting in case of severe ESLD with good results in the short- and long-term.
病态肥胖是一种全球性流行病，与非酒精性脂肪性肝病（NAFLD）密切相关，而NAFLD是肝移植（LT）越来越重要的适应证。肥胖影响着越来越多的肝移植受者，但这些患者的理想管理方式仍不明确。在肝移植背景下进行减重手术（BS）具有挑战性但可行，尽管关于减重手术的最佳时机仍存在争议。在此，我们报告一例肥胖青年成人接受高优先级肝移植并同期进行袖状胃切除术（SG）的病例。
一名45岁男性，患有病态肥胖（BMI 46 kg/m²）和严重的非酒精性脂肪性肝病相关终末期肝病（ESLD），由于终末期肝病模型（MELD）评分32，在紧急情况下接受了同期肝移植和袖状胃切除术。在长期随访期间，他体重显著减轻，糖尿病和高血压也得到缓解。在4年随访时，他的移植肝功能正常，免疫抑制剂血药浓度适宜，超声检查未发现脂肪变性迹象。
对于选定的患者，联合肝移植和袖状胃切除术在移植结局、体重减轻和肥胖相关合并症的缓解方面具有诸多优势。此外，在严重ESLD的高优先级情况下也可进行，短期和长期效果良好。
