Are We Ready for Bariatric Surgery in a Liver Transplant Program? A Meta-Analysis
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Are We Ready for Bariatric Surgery in a Liver Transplant Program? A Meta-Analysis Víctor Lopez-Lopez 1 & Juan José Ruiz-Manzanera 1 & Dilmurodjon Eshmuminov 2 & Kuno Lehmann 2 & Marcel Schneider 2 & Markus von der Groeben 3 & David Ruiz de Angulo 1 & Ursula Gajownik 4 & Jose Antonio Pons 4 & Francisco Sánchez-Bueno 1 & Ricardo Robles-Campos 1 & Pablo Ramírez-Romero 1 Received: 25 July 2020 / Revised: 30 October 2020 / Accepted: 10 November 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Obesity-related non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are two main causes of end-stage liver disease requiring a liver transplantation. Studies exploring bariatric surgery in the liver transplantation setting have increased in recent years; however, a systematic analysis of the topic is lacking to date. This meta-analysis was conducted to explore the perioperative and long-term outcomes of bariatric surgery in obese patients undergoing liver transplantation. Methods Electronic databases were systematically searched for studies reporting bariatric surgery in patients undergoing liver transplantation. The primary outcomes were postoperative complications and mortality. We also extracted data about excess weight loss, body mass index, and improvement of comorbidities after bariatric surgery. Results A total of 96 patients from 8 articles were included. Bariatric surgery–related morbidity and mortality rates were 37% (95% CI 0.27–0.47) and 0.6% (95% CI 0.02–0.13), respectively. Body mass index at 24 months was 31.02 (95% CI 25.96– 36.09) with a percentage excess weight loss at 12 and 24 months of 44.08 (95% CI 27.90–60.26) and 49.2 (95% CI 31.89–66.66), respectively. After bariatric surgery, rates of improvement of arterial hypertension and diabetes mellitus were 61% (95% CI 0.45– 0.75) and 45% (95% CI 0.25–0.66), respectively. In most patients, bariatric surgery was performed after liver transplant and the most frequent technique was sleeve gastrectomy. Conclusions Bariatric surgery can be performed safely in the setting of liver transplantation resulting in improvement of obesityrelated comorbidities. The optimal timing and technique require further studies. Keywords Liver transplant . Obesity . Non-alcoholic steatohepatitis . Non-alcoholic fatty liver disease . Bariatric surgery
Introduction The 2017 Organ Procurement and Transplantation Network/ Scientific Registry of Transplant Recipients (OPTN/SRTR) of
* Víctor Lopez-Lopez [email protected] 1
Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain
2
Department of Surgery and Transplantation, Swiss Hepato-Pancreato-Biliary (HPB) Center, University Hospital Zurich, Zurich, Switzerland
3
Department of Surgery, Hospital Muri, Muri, Switzerland
4
Department of Hepatology, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain
liver transplant
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