Date: Monday, June 3, 2019
Session Time: 2:30pm-4:00pm
Presentation Time: 3:06pm-3:18pm
Location: Ballroom A
*Purpose: Non-alcoholic steatohepatitis (NASH) cirrhosis is an increasingly common indication for liver transplantation (LT) in the United States and obese patients continue to be at risk for recurrence of NASH following LT. Intensive lifestyle and medical induced weight loss may prevent NASH recurrence following liver transplantation (LT) but, similar to obesity without liver disease, has rarely demonstrated a sustained effect. In contrast, bariatric surgery is remarkably effective in producing sustained weight loss.
*Methods: A single-institution, prospectively maintained database from 2014-2018 was queried for patients undergoing laparoscopic sleeve gastrectomy (LSG) following LT. The selection criteria for surgery were consistent with current NIH guidelines and patients were required to be a minimum of 6 months from their LT.
*Results: We identified 15 patients who underwent LSG following LT during the study period. The patients were predominantly Caucasian (86.7%) and female (60%), with median age of 59.0 years. Median time from LT to LSG was 2.2 (1.4-5.4) years and median follow-up was 2.6 (0.6-3.9) years. Following LSG, BMI decreased from 43.0 to 35.9 kg/m2 (p<0.001). In 12 patients with at least 1 year of follow-up, the percent total body weight loss was 20.6 % (14.5-27.6). Average daily insulin requirement decreased from 26.9 to 9.9 units/day following LSG (p<0.05). Four of six patients resolved their insulin dependence following LSG. The number of anti-hypertensive medications remained unchanged. No patients required conversion to an open procedure, one patient required ICU monitoring due to intra-operative blood loss, but did not require a transfusion. The median length of stay was 2 (1-2) days. There was one post-operative complication that consisted of a surgical site infection. There were no postoperative deaths.
*Conclusions: In the largest series to date, we demonstrate the safety and efficacy of laparoscopic sleeve gastrectomy in post-liver transplant recipients along with its pronounced effects on the resolution of T2DM. Our experience highlights the relatively low morbidity and mortality in the delayed approach compared to the previously reported outcomes in simultaneous LSG/LT.
To cite this abstract in AMA style:Morris MC, Jung AD, Kim Y, Dhar VK, Shah S, Schauer D, Smith E, Diwan T. The Impact of Sleeve Gastrectomy Following Liver Transplant in Patients with Non-Alcoholic Steatosis: A Five-Year Experience [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/the-impact-of-sleeve-gastrectomy-following-liver-transplant-in-patients-with-non-alcoholic-steatosis-a-five-year-experience/. Accessed April 10, 2020.
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