In the Journals

Liver transplant outcomes unaffected by prior bariatric surgery

Patients who underwent liver transplantation after prior bariatric surgery compared favorably to other transplant recipients in rates of graft survival, patient survival and posttransplant complications, according to a recently published study.

“We observed that posttransplant complications and survival among patients with a prior [bariatric surgery] were similar in comparison to the general transplant population,” Mohamed Safwan, MBBS, and colleagues wrote. “Notably, we did not observe an increase in body weight posttransplant for these patients. An improvement in liver function and good graft function posttransplant was noted.”

The study cohort comprised 11 patients with prior bariatric surgery who underwent liver transplantation between January 2006 and December 2015. Most patients underwent liver transplant for nonalcoholic steatohepatitis (90.9%).

Preoperative median total bilirubin was 5.7 mg/dL, aspartate aminotransferase was 415.1 IU/L, alanine aminotransferase was 489.4 IU/L, serum creatinine was 1.7 mg/dL, international normalized ratio was 2.3 and mean MELD score at the time of transplant was 28.4.

Mean interval between bariatric surgery and liver transplant was 11.6 years. “Most of the patients in our study had a long interval between [bariatric surgery] and LT,” the researchers wrote. “Although we do not know the factors why, we speculate that this may be due to earlier recognition of the need for [bariatric surgery] in obese patients. It could also be due to the improved understanding of increased surgical morbidity and mortality in decompensated cirrhosis.”

Patient and graft survival rates were both 81.8% at 1 year and 72.7% at 2 years among the patients with prior bariatric surgery. This was not significantly different compared with the observed overall survival rates at 1 (88.5%) and 2 years (84.1%) or average graft survival rates at 1 (85.6%) and 2 years (80.6%). The most common complications were biliary stricture (n = 3) and bile leak (n = 3).

“Despite a tendency towards weight gain in this population of patients with a history of NASH and often metabolic syndrome, their pre- and posttransplant weights were fairly stable at 1 year,” the researchers wrote. While mean BMI at the time of transplant was 31 kg/m2, mean BMI at 1, 6 and 12 months posttransplant was 28.3 kg/m2, 28 kg/m2 and 31 kg/m2, respectively.

Liver profile was stable posttransplant with mean AST of 32.9 IU/L at 6 months and 26.6 IU/L at 12 months and mean ALT of 28 IU/L at 6 months and 30.2 IU/L at 12 months.

“Our experience suggests that surgeons should have an understanding of the particular [bariatric surgery] procedure performed; in addition, during LT the surgeon should consider the possibility of difficult biliary access when determining the best method of biliary reconstruction; including the possibility of facilitating access to the biliary system postoperatively (for example, placement of a stent or access loop),” the researchers concluded. – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.

Patients who underwent liver transplantation after prior bariatric surgery compared favorably to other transplant recipients in rates of graft survival, patient survival and posttransplant complications, according to a recently published study.

“We observed that posttransplant complications and survival among patients with a prior [bariatric surgery] were similar in comparison to the general transplant population,” Mohamed Safwan, MBBS, and colleagues wrote. “Notably, we did not observe an increase in body weight posttransplant for these patients. An improvement in liver function and good graft function posttransplant was noted.”

The study cohort comprised 11 patients with prior bariatric surgery who underwent liver transplantation between January 2006 and December 2015. Most patients underwent liver transplant for nonalcoholic steatohepatitis (90.9%).

Preoperative median total bilirubin was 5.7 mg/dL, aspartate aminotransferase was 415.1 IU/L, alanine aminotransferase was 489.4 IU/L, serum creatinine was 1.7 mg/dL, international normalized ratio was 2.3 and mean MELD score at the time of transplant was 28.4.

Mean interval between bariatric surgery and liver transplant was 11.6 years. “Most of the patients in our study had a long interval between [bariatric surgery] and LT,” the researchers wrote. “Although we do not know the factors why, we speculate that this may be due to earlier recognition of the need for [bariatric surgery] in obese patients. It could also be due to the improved understanding of increased surgical morbidity and mortality in decompensated cirrhosis.”

Patient and graft survival rates were both 81.8% at 1 year and 72.7% at 2 years among the patients with prior bariatric surgery. This was not significantly different compared with the observed overall survival rates at 1 (88.5%) and 2 years (84.1%) or average graft survival rates at 1 (85.6%) and 2 years (80.6%). The most common complications were biliary stricture (n = 3) and bile leak (n = 3).

“Despite a tendency towards weight gain in this population of patients with a history of NASH and often metabolic syndrome, their pre- and posttransplant weights were fairly stable at 1 year,” the researchers wrote. While mean BMI at the time of transplant was 31 kg/m2, mean BMI at 1, 6 and 12 months posttransplant was 28.3 kg/m2, 28 kg/m2 and 31 kg/m2, respectively.

Liver profile was stable posttransplant with mean AST of 32.9 IU/L at 6 months and 26.6 IU/L at 12 months and mean ALT of 28 IU/L at 6 months and 30.2 IU/L at 12 months.

“Our experience suggests that surgeons should have an understanding of the particular [bariatric surgery] procedure performed; in addition, during LT the surgeon should consider the possibility of difficult biliary access when determining the best method of biliary reconstruction; including the possibility of facilitating access to the biliary system postoperatively (for example, placement of a stent or access loop),” the researchers concluded. – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.