Clinical Impact of Antecedent Bariatric Surgery on Liver Transplant Outcomes: A Retrospective Matched Case-Control Study

O. Serrano,¹ K. Peterson,¹ D. Vock,² D. Berglund,¹ R. Kandaswamy,¹ J. Lake,³ T. Pruett,¹ S. Chinnakotla.¹

¹Surgery, University of Minnesota, Minneapolis, MN
²Biostatistics, University of Minnesota, Minneapolis, MN
³Medicine, University of Minnesota, Minneapolis, MN.

Meeting: 2018 American Transplant Congress

Abstract number: C228

Keywords: Liver transplantation, Morbidity, Obesity, Outcome

Session Information

Session Name: Poster Session C: Liver: Recipient Selection

Session Type: Poster Session

Date: Monday, June 4, 2018

Session Time: 6:00pm-7:00pm

Presentation Time: 6:00pm-7:00pm

Location: Hall 4EF

OBJECTIVE: Bariatric surgery (BS) is associated with significant malabsorption and nutritional deficiencies, which can have profound consequences on the liver transplant (LT) patient. The magnitude of antecedent BS and its consequences on LT outcomes have not been adequately investigated.

METHODS: From March 1987 to January 2017, we performed 33 LT in patients with antecedent BS. To compare outcomes, we matched the BS cohort to LT recipients without BS (1:4 matching) based on exact matching for gender and hepatocellular carcinoma and inverse variance matching for age, BMI at transplant, MELD score, and transplant date.

RESULTS: We analyzed outcomes in 132 LT recipients performed at our institution between March 1987 and January 2017 (33 BS; 99 non-BS). The BS cohort comprised of 26 (79%) women with a mean age of 52.4 years. The BS procedures included 20 roux-en-Y gastric bypass (RYGB; 61%), 6 jejunoileal bypass (JIB; 18%), 3 gastric band (GB; 9%), 2 sleeve gastrectomy (SG; 6%), and 1 duodenal switch (DS; 3%). The average weight loss was 57.0 kg and excess weight loss (EWL) was 63.3%. The average length of time between BS and LT for the BS cohort was 16 years. The primary indications for LT listing were alcoholic cirrhosis (9; 27%), nonalcoholic steatohepatitis (7; 21%), hepatitis C (8; 24%), and hepatocellular carcinoma (3; 9%). At LT, the average BMI for the BS cohort was 29.6. Median follow-up among the BS cohort and matched controls was 5.2 years. Compared to matched controls BS recipients did not have significantly longer length of hospital stay (LOS) during LT admission (17.8 vs 15.7 days, p = 0.71), longer length of ICU stay at LT admission (5.3 vs 4.1 days, p = 0.16), or higher 30-day complication rate (76% vs 85%, p = 0.43). Overall patient survival was similar among the two groups (one- and three-year survival 90.1% and 75.9% for BS; 90.9% and 76.4% for non-BS, p = 0.34).

CONCLUSION: BS appears to be an effective strategy for weight management pre-LT in the obese LT candidate with minimal additive post-operative risk and comparable survival outcomes.

CITATION INFORMATION: Serrano O., Peterson K., Vock D., Berglund D., Kandaswamy R., Lake J., Pruett T., Chinnakotla S. Clinical Impact of Antecedent Bariatric Surgery on Liver Transplant Outcomes: A Retrospective Matched Case-Control Study Am J Transplant. 2017;17 (suppl 3).

To cite this abstract in AMA style:

Serrano O, Peterson K, Vock D, Berglund D, Kandaswamy R, Lake J, Pruett T, Chinnakotla S. Clinical Impact of Antecedent Bariatric Surgery on Liver Transplant Outcomes: A Retrospective Matched Case-Control Study [abstract]. https://atcmeetingabstracts.com/abstract/clinical-impact-of-antecedent-bariatric-surgery-on-liver-transplant-outcomes-a-retrospective-matched-case-control-study/. Accessed November 24, 2024.

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