Outcomes of sleeve gastrectomy in obese liver transplant candidates
Open accessAbstract
Morbid obesity (body mass index [BMI] ≥40 kg/m2) is a relative contraindication to liver transplantation (LT) at many transplant centers. The safety and efficacy of pre‐LT bariatric surgery in morbidly obese LT candidates is unknown. Herein, we describe a cohort study of morbidly obese LT candidates who failed to achieve adequate weight loss through a medically supervised weight loss program and subsequently underwent sleeve gastrectomy (SG) at our institution. In total, 32 LT candidates with a median Model for End‐Stage Liver Disease (MELD) score of 12 (interquartile range [IQR], 10‐13) underwent SG. All LT candidates had a history of hepatic decompensation, but complications of liver disease were required to be well controlled at the time of SG. Median pre‐SG BMI was 45.0 kg/m2 (IQR, 42.1‐49.0 kg/m2). There were no perioperative deaths or liver‐related morbidity. One patient experienced major perioperative morbidity secondary to a gastric leak, which was managed nonoperatively. Median weight loss at 6 and 12 months after SG was 22.0 kg (IQR, 18.9‐26.8 kg) and 31.0 kg (IQR, 23.6‐50.3 kg), respectively, corresponding to a percentage of excess body weight lost of 33.4% and 52.4%. Within 6 months after SG, 28 (88%) candidates were deemed eligible for LT. Our center’s experience highlights the potential option of SG in morbidly obese LT candidates with advanced liver disease who might otherwise be excluded from pursuing LT.
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In a series of 32 liver transplant candidates with well compensated cirrhosis (a third with MASLD alone), sleeve gastrectomy induced a median weight loss of 31 kg at 1 year after the procedure, with low morbidity, and allowed 88% of individuals to proceed with liver transplantation.
“In a series of 32 liver transplant candidates with well compensated cirrhosis (a third with MASLD alone) sleeve gastrectomy induced a median weight loss of 31 kg at 1 year after the procedure, with low morbidity, and allowed 88% of individuals to proceed with liver transplantation. 504”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [504]
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- Authors
- Sharpton, S. R., Terrault, N. A., & Posselt, A. M.
- Affiliations
- University of California, San Francisco (US)
- Corresponding author
- Posselt, Andrew M.
- Venue
- Liver Transplantation
- Published
- 2019-03-12
- Volume
- 25
- Issue
- 4
- Pages
- 538-544
- ISSN
- 1527-6465 (ISSN-L)
- 1527-6473
- PMC
- PMC6535047
- OpenAlex
- W2906878051
- Cited by
- 60
- References
- 28
- Citations by year
- 2026: 2 · 2025: 11 · 2024: 9 · 2023: 5 · 2022: 10 · 2021: 11 · 2020: 10 · 2019: 2
- FWCI
- 5.98
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- Liver Transplantation (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (T32DK060414)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Surgery › Organ Transplantation Techniques and Outcomes
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Keywords
- sleeve gastrectomy, morbid obesity, liver transplant candidates, bariatric surgery, weight loss, transplant eligibility, hepatic decompensation, MELD score, gastric leak, perioperative morbidity
- MeSH terms
- Female, Gastrectomy, Humans, Male, Middle Aged, Obesity, Morbid, Laparoscopy, Retrospective Studies, Severity of Illness Index, Waiting Lists, Weight Loss, Body Mass Index, Liver Transplantation, Treatment Outcome, Bariatric Surgery, Anastomotic Leak, End Stage Liver Disease, Weight Reduction Programs
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