Outcome of liver transplantation in patients with prior bariatric surgery.
Safwan M, Abouljoud M, and Salgia R. Outcome of liver transplantation in patients with prior bariatric surgery. Am J Transplant 2017; 17:580-581.
Am J Transplant
Aim: To study outcomes of liver transplantation (LT) patients with prior bariatric surgery (BS). Methods: Retrospective analysis performed on patients with LT between Jan 2006 and Dec 2015, to identify those with prior BS. Simultaneous liver-kidney transplantation (SLK) and multi-visceral transplantation (MVT) patients included. Results: 960 patients underwent LT; 12 (1.3%) had prior BS. Median follow-up was 31.5 months. Most common BS was Roux-en-y gastric bypass (n=10). Median interval between BS and LT was 9 years. Nine patients underwent LT alone, 2 SLK and 1 MVT. Most common indication for LT was NASH (n=10) with 5 (42%) having concurrent alcoholic liver disease. Median MELD was 28. Median lengthof-stay was 9 days. 30-day re-operation rate was 33% (n=4); indications were bile duct repair (n=3) and wound repair (n=1). In first 6 months after LT, most common complications were biliary strictures/leaks (n=6) and abdominal collections (n=3). Patient and graft survival rates at 1 and 2 years were 92% (n=11) and 83% (n=10). Eight patients (67%) had indications for liver biopsy post-LT; two (17%) showed macrovesicular steatosis. In patients with history of alcohol consumption, 2 (40%) relapsed post-LT. Two patients (17%) had history of diet-controlled diabetes pre-LT; one became insulin dependent post-LT. Median BMI pre-LT was 29.6. Median BMI at 1, 6, and 12 months post-LT was 26.9, 28.6, and 32.7. Median preoperative albumin was 2.4 mg/dl. Patients showed improvement in albumin post LT, with median albumin of 2.4 and 3.3 mg/dl, at 1 and 3 months. Liver profile stable post LT, with median AST of 30 and 22 IU/L and ALT of 21 and 28 IU/L, at 6 and 12 months. Conclusions: Outcomes of LT patients with prior BS are comparable to other transplant recipients with regards to patient and graft survival, and post-LT complication rates.