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Combining Bariatric Surgery with Organ Transplantation
Combining Bariatric Surgery with Organ Transplantation
Obesity can make kidney or liver transplant surgeries technically challenging and increase the risk of perioperative complications, so patients must meet a body mass index (BMI) threshold to be eligible for these procedures. Nonetheless, obesity-associated comorbidities—such as diabetes, high blood pressure, and non-alcoholic fatty liver disease—exacerbate the underlying problem and affect patients’ quality of life. Vadim Sherman, MD, Medical Director of the Bariatric and Metabolic Surgery Center, and colleagues in the J.C. Walter Jr. Transplant Center seek to address this problem by pairing bariatric surgery with the organ transplant.
Vadim Sherman, MD
For patients with obesity who require a kidney transplant, bariatric surgery can lower their BMI to make them eligible for transplantation, while also improving obesity-related comorbidities. The situation is more complicated, however, for patients with end-stage liver disease who require a liver transplant. “Any intervention is fraught with a high risk of mortality,” Dr. Sherman explains, so these patients cannot safely undergo bariatric surgery before transplantation. Instead, Dr. Sherman and colleagues are trying a different approach: sleeve gastrectomy—a less invasive form of bariatric surgery than gastric bypass—is performed during the second stage of the two-stage liver transplant procedure. Dr. Sherman and colleagues recently reported their experience treating 14 patients with this approach, where they found that the patients treated with the dual procedure had significantly greater excess weight loss but similar graft survival and postoperative outcomes after one year as 28 control patients who had obesity but underwent liver transplantation without sleeve gastrectomy. This innovative proof-of-concept study shows the feasibility and potential benefit of combining bariatric surgery with liver transplantation in patients with end-stage liver disease. “We, as bariatric surgeons, are stepping in,” Dr. Sherman says, “to improve the long-term health of these patients.”