Morbidly Obese Patients Awaiting Liver Transplantation. Sleeve Gastrectomy: Safety and Efficacy from a Liver Transplant Unit Experience

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BackgroundThe prevalence of obesity has increased dramatically, even in population awaiting a liver transplantation. Despite their associated complications, we cannot consider morbid obesity any longer as an absolute contraindication to liver transplantation. Dietary approaches alone are usually completely ineffective. Bariatric surgery is the gold-standard treatment for morbid obesity, and can be performed before, during or after transplantation.Materials and MethodsAt our Liver Transplantation Unit we performed a sleeve gastrectomy in 8 patients with liver cirrhosis due to NASH, alcohol or HCV, by a single surgeon. The Child score was A in 6 patients and B in the remaining 2 patients. Two of our patients had portal hypertension with mild esophageal varices. The procedure was performed laparoscopically in 7 cases (87,5%), and in the other case it was performed by open approach due to portal hypertension and according to patient preferences.ResultsPatients showed no postoperative morbidity or mortality. Mean postoperative BMI of our patients was 37.4/33.3/30.3 kg/m2 at 3/6/12 months after surgery. Mean %EWL of our patients was 42.9%/62.2%/76.3% at 3/6/12 months. Two of the patients have already undergone a successful liver transplant.ConclusionBariatric surgery in selected patients with compensated cirrhosis and without significative portal hypertension is reasonable. Therefore, there aren´t clear guidelines on the use of bariatric surgery in patients with cirrhosis. In our experience, the sleeve gastrectomy is safe and effective in the treatment of patients with compensated cirrhosis, and in a short time can improve candidacy in morbidly obese patients awaiting transplantation.

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