Sleeve gastrectomy decreases the incidence of metabolic syndrome in obese post-liver transplant patients

Abstract

Background: Metabolic syndrome (MS) after liver transplant poses a significant heath burden, with one-third of post liver transplant (OLT) patients developing recurrent non-alcoholic steatohepatitis (NASH). Bariatric surgery improves MS and NASH in the general population, however, this benefit is unknown in OLT patients. We aim to evaluate the efficacy of laparoscopic sleeve gastrectomy (LSG) as treatment of MS following OLT. Methods: A retrospective review of a single high-volume transplant center experience was performed. Over a 2-year period, 16 obese patients with a history of OLT were referred to our institution's metabolic surgery clinic. Of these, 11 patients underwent LSG. Patient demographics, comorbidities, body mass index (BMI), and 30-day complications were analyzed. Results: Median patient age was 61 years, pre-OLT BMI was 42.7 kg/m2 , and BMI prior to LSG was 40.0 kg/m2 . Median interval from transplant to LSG was 2.7 years and median follow-up after LSG was 375 days. For patients with 1 year follow-up (n = 7), median BMI was 33.3 kg/m2 , mean percent excess weight loss was 48.0% ± 21.0% and mean percent total body weight loss was 23.4% ± 8.9%. Incidence of MS was reduced by 75%. A 53% reduction in anti-hypertensive medications was seen and 2 of 3 patients discontinued insulin completely. While one patient required two units of blood post-operatively, there were no other complications. Patients without a LSG (n = 5) did not experience weight loss with a medical weight loss program (median pre-OLT BMI 33.7 kg/m2 , median post-OLT BMI 40.3 kg/m2 , and most recent median BMI 39.7 kg/m2 ) and none achieved resolution of MS. Conclusion: LSG is safe and effective for the management of obesity and metabolic syndrome in the post OLT population. By reducing the prevalence of MS after OLT, LSG may decrease the incidence of recurrent NASH.