Background:

Prior bariatric surgery in cirrhotics is increasingly common, and the metabolic derangements and altered anatomy from this surgery may impact outcomes. We hypothesize that cirrhotic patients with prior bariatric surgery have increased rates of wait list mortality and delisting, as well as reduced post-transplant survival.

Methods:

We evaluated all cirrhotics (1999-2014) having bariatric surgery and undergoing LT evaluation using a prospectively maintained database, comparing them to a matched control group (age, MELD at evaluation and disease etiology). We examined waitlist mortality, delisting rate, transplant incidence and intent-to-treat survival from listing to 1 year after LT.

Results:

The study cohort (n=78) had 63% Roux-en-y gastric bypass, median 7 yrs post bariatric surgery to evaluation with a mean 130lb weight loss in that time, and a mean initial evaluation MELD of 21.5. Of the evaluated cirrhotics with bariatric surgery, only 24% were transplanted (84% white females, mean BMI 31.5, mean MELD 28.7).

Compared to matched controls, transplant candidacy rejection was similar (42.3% vs. 55%, p=0.06), delisting/death on waiting list was higher (35.5% vs 12.8%, p<0.01), and transplantation rate was lower (42.2% vs. 64.3%, p=0.02). KM patient survival from time of listing was lower in cirrhotics having prior bariatric surgery. On multivariable analysis, bariatric surgery was associated with increased risk of death (HR= 1.9, 95%CI 1-3.7), although that risk was attenuated when adjusted for MELD and malnutrition (HR=1.4 95% CI 0.6-3).

Conclusion:

Bariatric surgery prior to liver transplantation is associated with an increased risk of death following listing, part of which is attributed to disease severity and malnutrition.

CITATION INFORMATION: Asrani S, Khan F, Saracino G, McKenna G, Hasse J, Klintmalm G, Trotter J. Bariatric Surgery and Increased Risk of Death After Listing for Liver Transplantation. Am J Transplant. 2016;16 (suppl 3).

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