High-priority liver transplantation and simultaneous sleeve gastrectomy in MELD 32 end-stage liver disease: a case report with long-term follow-up. Issue 1 (January 2022)

• Record Type: Journal Article
• Authors: Anselmo, Alessandro; Siragusa, Leandro; Sensi, Bruno; Bacchiocchi, Giulia; Pellicciaro, Marco; Manzia, Tommaso Maria; Gentileschi, Paolo; Tisone, Giuseppe
• Is Part Of: Obesity research & clinical practice. Volume 16:Issue 1(2022)
• Page Start: 91
• Page End: 94
• Publication Date: 2022-01
• Subjects: LT Liver Transplantation -- BS bariatric surgery -- SG sleeve gastrectomy -- BMI Body Max Index -- MELD Model End-Stage Liver Disease -- NAFLD non-alcoholic fatty liver disease -- NASH non-alcoholic steatohepatitis -- ESLD end-stage liver disease; Liver transplantation -- Bariatric surgery -- Sleeve gastrectomy; Obesity -- Research -- Periodicals; Obesity -- Treatment -- Periodicals; Obesity -- Periodicals; Obésité -- Recherche -- Périodiques; Obésité -- Traitement -- Périodiques; Obesity -- Research; Obesity -- Treatment; Electronic journals; Periodicals; 616.398
• DOI: 10.1016/j.orcp.2022.01.001
• Languages: English
• ISSNs: 1871-403X

Abstract

Abstract: Background: Morbid obesity is a worldwide epidemic closely linked to Non-Alcoholic Fatty Liver Disease (NAFLD), an ever more relevant indication for Liver Transplantation (LT). Obesity affects an increasing number of LT recipients, but the ideal management of these patients remain unclear. Bariatric surgery (BS) in LT setting is challenging but feasible, although the debate is still open about the best timing of bariatric surgery. Herein we report a case of high-priority LT and simultaneous sleeve gastrectomy (SG) in an obese young adult. Case report: A 45 years old man with morbid obesity (BMI 46 kg/m 2 ) and severe NAFLD-related end-stage liver disease (ESLD) underwent simultaneous LT and sleeve gastrectomy (SG) in an emergency setting, due to a MELD score of 32. He had substantial weight loss during long-term follow-up and enjoyed resolution of diabetes and hypertension. At 4 years follow-up, he has normal allograft function with appropriate immunosuppressant blood levels and no ultrasound evidence of steatosis. Conclusion: In selected patients, combined LT and SG present several advantages in terms of transplant outcomes, weight loss and resolution of obesity-related comorbidities. In addition, it can be performed in the high-priority setting in case of severe ESLD with good results in the short- and long-term.