Bariatric surgery post-Liver Transplantation: A Belgian nationwide study

Louis Onghena; Anja Geerts; Frederik Berrevoet; Jacques Pirenne; Jef Verbeek; Eliano Bonaccorsi-Riani; Geraldine Dahlqvist; Luisa Vonghia; Olivier Detry; Jean Delwaide; Sander Lefere; Yves van Nieuwenhove

doi:10.1097/LVT.0000000000000372

Bariatric surgery post-Liver Transplantation: A Belgian nationwide study

Liver Transpl. 2024 Apr 1. doi: 10.1097/LVT.0000000000000372. Online ahead of print.

Authors

Louis Onghena^{1

2

3

4}, Anja Geerts^{3

4}, Frederik Berrevoet², Jacques Pirenne⁵, Jef Verbeek⁶, Eliano Bonaccorsi-Riani^{7

8}, Geraldine Dahlqvist⁹, Luisa Vonghia¹⁰, Olivier Detry¹¹, Jean Delwaide¹², Sander Lefere^{3

4}, Yves van Nieuwenhove¹

Affiliations

¹ Department for Human Structure and Repair, Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium.
² Department for Human Structure and Repair, Department of General and Hepatobiliary Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium.
³ Department of Internal Medicine and Pediatrics, Hepatology Research Unit, Ghent University, Ghent, Belgium.
⁴ Liver Research Center Ghent, Ghent University, Ghent University Hospital, Ghent, Belgium.
⁵ Department for Abdominal Transplant Surgery and Coordination, University Hospitals Leuven, Leuven, Belgium.
⁶ Department of Gastroenterology & Hepatology, University Hospitals Leuven, Leuven, Belgium.
⁷ Abdominal Transplant Unit, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.
⁸ Pôle de Chirurgie Expérimentale et Transplantation, Institute de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium.
⁹ Department of Hepatogastroenterology and Liver Transplantation, University Hospitals Saint-Luc, Brussels, Belgium.
¹⁰ Division of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerp, Belgium.
¹¹ Department of Abdominal Surgery and Transplantation, CHU Liege, Liege, Belgium.
¹² Department of Hepatogastroenterology, CHU Liege, Liege, Belgium.

PMID: 38551388
DOI: 10.1097/LVT.0000000000000372

Abstract

Background: Weight gain poses a rising concern post-liver transplantation (LT), and metabolic dysfunction-associated steatotic liver disease (MASLD) might impair graft health. The timing is crucial when considering bariatric surgery (BS) in a population with liver disease or transplantation. BS can be considered for post-LT weight gain, although the evidence is limited and the long-term outcome still uncertain.

Methods: We conducted a national retrospective analysis in 5 Belgian transplant centres and included 25 patients with a liver transplantation followed by a bariatric procedure. 187 LT patients without BS were included for comparison. Clinical, biochemical and outcome data were retrospectively retrieved.

Results: In our nationwide cohort, 25 patients had undergone BS post-LT, at a median 3.5 years after LT. Twenty-one (84.0%) patients received a sleeve gastrectomy (SG). Patients were predominantly male (72.0%), with a lower age at time of transplantation compared to non-BS population (54.5 vs. 60.6, p<0.001). Weight loss was significant and sustained, with a decrease in BMI from 41.0±4.5 pre-BS to 32.6±5.8 1-3 years post-BS (p<0.001) and 31.1±5.8 3-5 years post-BS (p<0.001). Post-LT pre-BS three (12.0%) patients presented with recurrent and one (4.0%) de novo MASLD, with 100% resolution post-BS (p=0.016). Notable reductions were observed in ALT levels (40.5±28.5 U/L to 27.1±25.1 U/L post-BS, p=0.05) and HbA1c levels (6.9±1.6 to 6.0±1.4 post-BS, p<0.001). Three patients were re-transplanted, and eight patients died, of which five (20.0%) due to a non-hepatic malignancy and one (4.0%) due to liver failure.

Conclusions: SG is the favored BS post-LT and has proven to be safe and feasible in a post-LT setting with favorable metabolic consequences. SG post-LT is a valid treatment for de novo and recurrent MASLD post-LT. Although we report on the largest cohort to date, there is still a need for larger cohorts to examine the effect of BS on patient and graft survival.