Introduction: Liver transplantation in patients with prior gastric bypass poses a unique challenge and may increase the risk of complications.

Aim: To characterize surgical complications in liver transplant recipients with prior gastric bypass.

Methods: We retrospectively reviewed all liver transplant [LT] recipients with history of gastric bypass, who underwent liver transplantation at our institute from January 2012 to September 2017. We characterized surgical complications grade 3 or more occurring in first 6 months post LT.

Results: Of the 563 liver transplant recipients at our institution over past five years, 9 [1.6 %] had prior gastric bypass. One amongst these 9 patients had a simultaneous liver kidney transplant. Most frequent indications were alchoholic liver disease (5), hepatitis (2), NASH (1) and acetaminophen overdose (1). The mean recipient age was 50 years, body mass index (BMI) at LT was 28.5[thinsp]kg/m2 and follow up was 491 days post LT. We observed surgical complications in 3 patients, including perforation at prior gastro-jejunal anastomosis requiring laparotomy post-LT and primary repair in 2 patients and a G tube related bowel injury (which was placed to provide nutritional support) necessitating laparotomy and primary repair in one patient. The mean length of hospital stay in the 3 patients with surgical complications was higher than those without complications (43days vs 13 days). All 9 recipients in this study are alive and continue to have excellent graft function.

Conclusion: Prior gastric bypass surgery may increase the risk of surgical complications in liver transplant recipients However in our experience graft function and patient survival was not affected. Pre- transplant GI anatomy and function, including anastomotic integrity, and nutritional status are important parameters to be evaluated during recipient selection. A high level of suspicion for post-transplant anastomotic leaks or bowel perforation in this subset of patients is suggested.

CITATION INFORMATION: Vijay A., Nigam A., Girlanda R., Kroemer A., Hawksworth J., Matsumoto C., Fishbein T. Liver Transplantation Post Gastric Bypass: Surgical Complications and Outcomes Am J Transplant. 2017;17 (suppl 3).

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