Combined liver transplantation and sleeve gastrectomy for end-stage liver disease in a bariatric patient: First European case-report

Laura Tariciotti; Stefano D'Ugo; Tommaso Maria Manzia; Valeria Tognoni; Giuseppe Sica; Paolo Gentileschi; Giuseppe Tisone

doi:10.1016/j.ijscr.2016.09.011

Combined liver transplantation and sleeve gastrectomy for end-stage liver disease in a bariatric patient: First European case-report

Int J Surg Case Rep. 2016:28:38-41. doi: 10.1016/j.ijscr.2016.09.011. Epub 2016 Sep 21.

Authors

Laura Tariciotti¹, Stefano D'Ugo², Tommaso Maria Manzia³, Valeria Tognoni², Giuseppe Sica², Paolo Gentileschi², Giuseppe Tisone³

Affiliations

¹ Liver and Kidney Transplant Centre, Fondazione Policlinico "Tor Vergata", University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy. Electronic address: laura.tariciotti@gmail.com.
² General Surgery and Bariatric Surgery Unit, Fondazione Policlinico "Tor Vergata", University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy.
³ Liver and Kidney Transplant Centre, Fondazione Policlinico "Tor Vergata", University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy.

Abstract

Introduction: Obesity is a contributor to the global burden of chronic diseases, including non-alcoholic fatty liver disease and non-alcoholic steatohepatitis (NASH). NASH cirrhosis is becoming a leading indication for liver transplant (LT). Obese transplanted patients have higher morbidity and mortality rates. One strategy, to improve the outcomes in these patients, includes bariatric surgery at the time of LT. Herein we report the first European combined LT and sleeve gastrectomy (SG).

Case presentation: A 53 years old woman with Hepatocellular carcinoma and Hepatitis C virus related cirrhosis, was referred to our unit. She also presented with severe morbid obesity (BMI 40kg/m²) and insulin-dependent diabetes. Once listed for LT, she was assessed by the bariatric surgery team to undergo a combined LT/SG. At the time of transplantation the patient had a model for end-stage liver disease calculated score of 14 and a BMI of 38kg/m². The LT was performed using a deceased donor. An experienced bariatric surgeon, following completion of the LT, performed the SG. Operation time was 8h and 50min. The patient had an uneventful recovery and is currently alive, 5 months after the combined procedure, with normal allograft function, significant weight loss (BMI=29kg/m²), and diabetes resolution.

Conclusion: Despite the ideal approach to the management of the obese LT patients remains unknown, we strongly support the combined procedure during LT in selected patients, offering advantages in terms of allograft and patient survival, maintenance of weigh loss that will ultimately reduce obese related co-morbidities.

Keywords: Bariatric surgery; Case report; Liver transplantation; Non-alcoholic steatohepatitis cirrhosis; Obesity; Sleeve gastrectomy.