BACKGROUND: Obesity-related non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are two main causes of end-stage liver disease requiring a liver transplantation. Studies exploring bariatric surgery in the liver transplantation setting have increased in recent years; however, a systematic analysis of the topic is lacking to date. This meta-analysis was conducted to explore the perioperative and long-term outcomes of bariatric surgery in obese patients undergoing liver transplantation. METHODS: Electronic databases were systematically searched for studies reporting bariatric surgery in patients undergoing liver transplantation. The primary outcomes were postoperative complications and mortality. We also extracted data about excess weight loss, body mass index, and improvement of comorbidities after bariatric surgery. RESULTS: A total of 96 patients from 8 articles were included. Bariatric surgery-related morbidity and mortality rates were 37% (95% CI 0.27-0.47) and 0.6% (95% CI 0.02-0.13), respectively. Body mass index at 24 months was 31.02 (95% CI 25.96-36.09) with a percentage excess weight loss at 12 and 24 months of 44.08 (95% CI 27.90-60.26) and 49.2 (95% CI 31.89-66.66), respectively. After bariatric surgery, rates of improvement of arterial hypertension and diabetes mellitus were 61% (95% CI 0.45-0.75) and 45% (95% CI 0.25-0.66), respectively. In most patients, bariatric surgery was performed after liver transplant and the most frequent technique was sleeve gastrectomy. CONCLUSIONS: Bariatric surgery can be performed safely in the setting of liver transplantation resulting in improvement of obesity-related comorbidities. The optimal timing and technique require further studies.
BACKGROUND:Obesity-related non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are two main causes of end-stage liver disease requiring a liver transplantation. Studies exploring bariatric surgery in the liver transplantation setting have increased in recent years; however, a systematic analysis of the topic is lacking to date. This meta-analysis was conducted to explore the perioperative and long-term outcomes of bariatric surgery in obesepatients undergoing liver transplantation. METHODS: Electronic databases were systematically searched for studies reporting bariatric surgery in patients undergoing liver transplantation. The primary outcomes were postoperative complications and mortality. We also extracted data about excess weight loss, body mass index, and improvement of comorbidities after bariatric surgery. RESULTS: A total of 96 patients from 8 articles were included. Bariatric surgery-related morbidity and mortality rates were 37% (95% CI 0.27-0.47) and 0.6% (95% CI 0.02-0.13), respectively. Body mass index at 24 months was 31.02 (95% CI 25.96-36.09) with a percentage excess weight loss at 12 and 24 months of 44.08 (95% CI 27.90-60.26) and 49.2 (95% CI 31.89-66.66), respectively. After bariatric surgery, rates of improvement of arterial hypertension and diabetes mellitus were 61% (95% CI 0.45-0.75) and 45% (95% CI 0.25-0.66), respectively. In most patients, bariatric surgery was performed after liver transplant and the most frequent technique was sleeve gastrectomy. CONCLUSIONS: Bariatric surgery can be performed safely in the setting of liver transplantation resulting in improvement of obesity-related comorbidities. The optimal timing and technique require further studies.
Authors: Philip R Schauer; Deepak L Bhatt; John P Kirwan; Kathy Wolski; Ali Aminian; Stacy A Brethauer; Sankar D Navaneethan; Rishi P Singh; Claire E Pothier; Steven E Nissen; Sangeeta R Kashyap Journal: N Engl J Med Date: 2017-02-16 Impact factor: 91.245
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Authors: Debashis Haldar; Barbara Kern; James Hodson; Matthew James Armstrong; Rene Adam; Gabriela Berlakovich; Josef Fritz; Benedikt Feurstein; Wolfgang Popp; Vincent Karam; Paolo Muiesan; John O'Grady; Neville Jamieson; Stephen J Wigmore; Jacques Pirenne; Seyed Ali Malek-Hosseini; Ernest Hidalgo; Yaman Tokat; Andreas Paul; Johann Pratschke; Michael Bartels; Pavel Trunecka; Utz Settmacher; Massimo Pinzani; Christophe Duvoux; Philip Noel Newsome; Stefan Schneeberger Journal: J Hepatol Date: 2019-05-07 Impact factor: 25.083
Authors: Eduardo de Souza M Fernandes; Felipe Pedreira Tavares de Mello; Leandro Savattone Pimentel; Ronaldo de Oliveira Andrade; Camila Girão; Camilla César; Luciana Janene El-Kadre; Fernando de Barros; Henrique Sergio Moraes Coelho; Anderson Brito; Claudia Cristina Tavares de Sousa; Orlando Jorge M Torres Journal: Updates Surg Date: 2022-02-01