Department of General Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA.
Department of Transplant, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA.
Obes Surg. 2022 Nov;32(11):3600-3604. doi: 10.1007/s11695-022-06289-1. Epub 2022 Sep 28.
Nonalcoholic steatohepatitis (NASH) associated with obesity is one of the leading causes of liver failure requiring transplant, yet guidelines for the management of obesity in these scenarios are not always followed. In order to decrease incidence of NASH in the new liver, we studied the feasibility of simultaneous liver transplant and bariatric surgery.
We retrospectively identified patients who underwent simultaneous liver transplant and sleeve gastrectomy at our hospital site between November 24, 2019, and April 14, 2022. Demographics, surgical data, postoperative adverse events, and weight loss data were collected.
Ten patients met inclusion criteria. Mean body mass index (BMI) at the time of transplant was 43.1 ± 5.3 kg/m, and mean length of hospital stay was 10.8 ± 5.22 days. Within 30 days after surgery, 7 patients reported adverse effects, and 2 were readmitted. Mean BMI at 6-month follow-up was 30.6 ± 2.5 kg/m. Mean percentage excess weight (in pounds) loss was 48.1 ± 11.4%, 58.6 ± 8.9%, and 66.1 ± 15.3% at 3-, 6-, and 12-month follow-up, respectively. Three patients had an increase in weight at 12-month follow-up when compared to 6-month follow-up. Most patients required fewer comorbidity-related medications, and none reported adverse effects related to sleeve gastrectomy.
Bariatric surgery at the time of liver transplant is safe and has minimal adverse effects. Results include substantial postoperative weight loss, improvement in comorbidities, and decreased risk of NASH in the new liver. Further studies with larger cohorts are required to confirm the findings of this study.
与肥胖相关的非酒精性脂肪性肝炎（NASH）是导致肝衰竭需要移植的主要原因之一，但在这些情况下，肥胖管理的指南并不总是得到遵循。为了降低新肝脏中 NASH 的发生率，我们研究了同时进行肝移植和减肥手术的可行性。
我们回顾性地确定了 2019 年 11 月 24 日至 2022 年 4 月 14 日期间在我们医院进行同时肝移植和袖状胃切除术的患者。收集了人口统计学、手术数据、术后不良事件和体重减轻数据。
10 名患者符合纳入标准。移植时的平均体重指数（BMI）为 43.1±5.3kg/m2，平均住院时间为 10.8±5.22 天。术后 30 天内，7 名患者报告了不良反应，2 名患者再次入院。6 个月随访时的平均 BMI 为 30.6±2.5kg/m2。术后 3、6 和 12 个月随访时，平均超重百分比（磅）损失分别为 48.1±11.4%、58.6±8.9%和 66.1±15.3%。与 6 个月随访时相比，3 名患者在 12 个月随访时体重增加。大多数患者需要较少的合并症相关药物，并且没有人报告与袖状胃切除术相关的不良反应。
肝移植时进行减肥手术是安全的，并且具有最小的不良反应。结果包括大量的术后体重减轻、合并症的改善以及新肝脏中 NASH 的风险降低。需要更大队列的进一步研究来证实本研究的结果。
