Bariatric Surgery to Improve Candidacy for Liver Transplantation: A Systematic Review and Meta-Analysis
1University of Alabama at Birmingham, Birmingham, AL, 2University of Southern California, Los Angeles, CA
Meeting: 2020 American Transplant Congress
Abstract number: C-167
Keywords: Liver transplantation, Meta-analysis, Obesity, Waiting lists
Session Information
Session Name: Poster Session C: Liver: Recipient Selection
Session Type: Poster Session
Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
Location: Virtual
*Purpose: As non-alcoholic steatohepatitis grows as an indication for liver transplant, the challenge managing obese pre-liver transplant patients will become more pronounced, especially because most transplant centers use a BMI cutoff for listing. In this population, traditional weight loss methods are unlikely to produce sufficient weight loss to achieve listing. Bariatric surgery may be an effective tool to achieve listing in these patients.
*Methods: 790 manuscripts were identified through a PubMed search for any bariatric surgery and any solid-organ transplant. Included studies must have used bariatric surgery as a means for weight loss in end-stage liver failure patients with the goal of achieving listing for transplant. After abstract screening, 173 full texts were reviewed. 3 examined bariatric surgery in potential liver transplant candidates. Reasons for exclusion included: bariatric surgery not performed to increase transplant candidacy, non-English language manuscript, editorials/reviews, and decision modeling analyses.
*Results: 41 patients underwent bariatric surgery to improve candidacy for liver transplant. They were mostly female (70.7%) with a mean age of 50.9(11.2). All underwent sleeve gastrectomy. The most common indications for transplant were hepatitis C (17; 41.5%), followed by NASH (16; 39.0%). 66.7% of patients reached a BMI<40 kg/m2within 6 months of bariatric surgery. Additionally, 58.5% were able to be waitlisted and 41.5% were ultimately transplanted at a mean time from surgery of 9.0(2.6) months. 9 of 41 (21.9%) of the patients in this group improved enough following bariatric surgery that they no longer required listing for liver transplant. Among the 41 patients, 3 complications were reported within 30 days of the bariatric surgery (Clavien-Dindo Class I (x2), Class IIIa).
*Conclusions: These studies suggest bariatric surgery may be an effective tool to increase transplant candidacy in obese patients. However, publication bias and candidate selection may limit generalizability. Larger, systematic studies are needed. candidates.
To cite this abstract in AMA style:
Purvis J, Stahl R, Grams J, Gray M, Eckhoff D, Cannon R, Lewis C, Terrault N, Locke J, Orandi B. Bariatric Surgery to Improve Candidacy for Liver Transplantation: A Systematic Review and Meta-Analysis [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/bariatric-surgery-to-improve-candidacy-for-liver-transplantation-a-systematic-review-and-meta-analysis/. Accessed November 22, 2024.« Back to 2020 American Transplant Congress