Study on Post-Operative Weight Gain in Liver Transplant Patients
Increasing Liver Transplants in Obese Patients
Liver transplants among obese patients with fatty liver deposits are on the rise in the United States. In 2014, the leading cause of liver transplantation was liver failure resulting from fat deposits that hinder normal liver function. However, obese patients face challenges in reaching the top of the waiting list for transplants. Previous studies indicate that obesity increases the risk of complications during liver transplants, as metabolic and cardiovascular diseases linked to obesity can lead to higher mortality rates post-transplant. Consequently, many patients are often denied access to transplant services until they achieve a body mass index (BMI) below an acceptable level, a goal that can be difficult for individuals with complicated obesity.
New Protocol Developed in 2006
To tackle the challenges faced by these patients, liver transplant surgeons at the Mayo Clinic established a new protocol in 2006. Under this protocol, if patients remained above a critical BMI when they reached the top of the waiting list and a liver became available, the transplant would proceed alongside a simultaneous weight loss surgery. This weight loss surgery involved a sleeve gastrectomy, a procedure that reduces the stomach size.
Long-Term Outcome Review Published
Recent findings regarding the long-term outcomes of this new protocol were published in the journal Hepatology. The study compared the weight dynamics, metabolic outcomes, and quality of life among 36 patients who underwent liver transplant alone with eight patients who received both liver transplant and weight loss surgery.
Results of Combined Liver Transplant and Weight Loss Surgery
Patients who underwent liver transplantation in conjunction with weight loss surgery experienced more significant and stable weight loss post-surgery. Specifically, these patients maintained a weight loss of nearly 35% three years after the procedure, compared to just 13% in those who had a liver transplant alone. Additionally, metabolic health indicators were found to be better in patients who underwent the combined procedure. Quality of life assessments showed no significant differences between the two patient groups after surgery.
Conclusions and Future Considerations
The researchers concluded that the combination of weight loss surgery and liver transplantation led to more effective and lasting weight loss, as well as reduced metabolic complications. However, the quality of the research does not yet support a clear recommendation for this combined surgical approach.
Questions About Timing of Procedures
Researchers are now exploring whether the liver transplant and weight loss surgery should be performed simultaneously or if the weight loss procedure should be delayed by several months. They also contemplate the benefits of weight loss surgery for patients who have successfully lost weight prior to the transplant, as they may experience more sustained weight loss in the long term. A larger patient cohort undergoing this combined approach and further examination of the results will be necessary to address these questions.
Author and Reference
Written by Nicola Cribb, VetMB DVSc Dip.ACVS
Reference: Zamora‐Valdes D, Watt K, Kellogg T, et al. Long‐term outcomes of patients undergoing simultaneous liver transplantation and sleeve gastrectomy. Hepatology. 2018;68(2):485–495. doi:10.1002/hep.29848.