Outcomes of Bariatric Surgery After Solid Organ Transplantation
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Outcomes of Bariatric Surgery After Solid Organ Transplantation Yilon Lima Cheng 1 & Enrique F. Elli 1 Received: 4 August 2020 / Revised: 22 September 2020 / Accepted: 24 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Obesity is prevalent after orthotopic solid organ transplant mainly due to immunosuppressive therapy, decreased physical activity, and unbalanced diet, which leads to development or worsening of other comorbidities, such as hypertension and type 2 diabetes mellitus. Morbid obesity increases the risk of graft loss and has negative effects on postoperative morbidity and patient survival. The aim of this study was to assess the safety and effectiveness of bariatric surgery after organ transplant. Material and Methods A retrospective analysis of patients who underwent bariatric surgery after organ transplant between July 1, 2010, and June 30, 2019, was performed. Demographics, surgical data, immunosuppressive treatment, postoperative adverse events, and weight loss were collected. Results Thirty-eight patients met inclusion criteria. The median (range) time between transplant and bariatric surgery was 54.3 (10.0–253.0) months. Laparoscopic sleeve gastrectomy and robotic Roux-en-Y gastric bypass were performed in 28 and 10 patients, respectively. Only 1 conversion to open procedure was required. Median length of stay was 2 days, with a 30-day adverse event rate of 23.7%. No leaks were documented. At 12-month follow-up, mean (SD) percentage excess body weight loss was 58.54 (21.91) and 68.74 (23.13) after sleeve gastrectomy and Roux-en-Y gastric bypass, respectively. Comorbidity-related medications were decreased in most patients, while transplant organ rejection occurred in 2 patients. Conclusion Bariatric surgery after organ transplant enables considerable postoperative weight loss and improvement of obesityrelated comorbidities; however, it presents with higher morbidity. Keywords Bariatric surgery . Gastric bypass . Organ transplantation . Sleeve gastrectomy
Introduction Obesity is a major health concern as it affects 39.6% of the US adult population [1]. In patients undergoing orthotopic solid organ transplant (OSOT), obesity prevalence rises from 5.6% before transplant to 11.5% 1 year after [2]. It is a multifactorial condition usually related to immunosuppressive treatment, decreased physical activity, unbalanced diet, and endocrine Presented at the 24th International Federation for the Surgery of Obesity and Metabolic Disorders World Congress, Madrid, Spain, September 3-7, 2019. Portions of this manuscript have been published in abstract form: Diaz Vico T, Elli EF. O-126 Minimally invasive bariatric surgery for obese patients after solid organ transplantation: safety and feasibility. Obes Surg 2019;29:150. * Enrique F. Elli [email protected] 1
Division of General Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
and metabolic changes [3]. Morbid obesity increases the risk of graft loss and delaye
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