Safety and efficacy of simultaneous liver transplantation and sleeve gastrectomy in morbid obese end-stage liver disease patients: The LT-SG study.

IF 4.7 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Liver Transplantation Pub Date : 2024-10-28 DOI:10.1097/LVT.0000000000000522

Tommaso Maria Manzia, Bruno Sensi, Paolo Gentileschi, Claudia Quaranta, Luca Toti, Leonardo Baiocchi, Mario Dauri, Roberta Angelico, Giuseppe Tisone

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引用次数: 0

Abstract

Introduction: In obese patients, metabolic dysfunction-associated steatotic liver disease is becoming a leading aetiology of end-stage liver disease and hepatocellular carcinoma. Simultaneous liver transplantation and sleeve gastrectomy (LT-SG) has been proposed in the US, but the safety and efficacy of the procedure have not been widely explored in Europe.

Methods: Between January 2016 and December 2022, morbidly obese patients listed for LT at Tor Vergata University were enrolled in the LT-SG study. Primary outcomes were: i) safety expressed as 30- and 90-days overall survival (OS) and ii) major postoperative complications (Clavien-Dindo > IIIa). The secondary outcome was efficacy expressed as a 3-year %excess BMI loss(%EBMIL).

Results: Eleven patients were enrolled in the study. The median BMI at transplantation was 42 (IQR 38-48). Indications to LT-SG were HCC (63.6%) and cirrhosis (36.4%). In 54% of cases, donors had high-risk characteristics (ET-DRI>1.6). The 30 and 90-day OS were 63.6% and 54.5%, respectively. All deaths occurred in patients with p-SOFT>15 or in patients who had at least three of the following characteristics: >60 years, BMI >45, metabolic syndrome, MELD>25 or ET-DRI >1.6. The six months, 1, 2 and 3 years %excess BMI loss was 73%, 60%, 50% and 43%, respectively.

Conclusions: LT-SG is a complex procedure thatmay carry excess risk in an unselected population. It should be considered only in highly selected patients. Standard donors are recommended and prioritization of severely obese patients on the waiting list should be considered.

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病态肥胖终末期肝病患者同时接受肝移植和袖状胃切除术的安全性和有效性：LT-SG研究。

简介在肥胖患者中，代谢功能障碍相关脂肪性肝病正成为终末期肝病和肝细胞癌的主要病因。美国已提出同时进行肝移植和袖状胃切除术（LT-SG），但该手术的安全性和有效性在欧洲尚未得到广泛探讨：2016年1月至2022年12月期间，托尔韦尔加塔大学病态肥胖的肝移植患者被纳入LT-SG研究。主要结果为：i）安全性，以30天和90天的总生存率（OS）表示；ii）主要术后并发症（Clavien-Dindo > IIIa）。次要结果是疗效，以 3 年超重体重指数下降率（%EBMIL）表示：共有 11 名患者参与了这项研究。移植时的中位体重指数为 42（IQR 38-48）。LT-SG的适应症为HCC（63.6%）和肝硬化（36.4%）。54%的病例中，供体具有高风险特征（ET-DRI>1.6）。30天和90天的OS分别为63.6%和54.5%。所有死亡病例均发生在p-SOFT>15或具有以下至少三个特征的患者中：年龄>60岁、体重指数>45、代谢综合征、MELD>25或ET-DRI>1.6。6个月、1年、2年和3年的BMI超标率分别为73%、60%、50%和43%：LT-SG是一种复杂的手术，在未经选择的人群中可能存在过高的风险。结论：LT-SG 是一种复杂的手术，在未经选择的人群中可能存在过高的风险，只有经过严格筛选的患者才应考虑使用。建议使用标准供体，并应考虑优先考虑候选名单上的严重肥胖患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Liver Transplantation 医学-外科

CiteScore

7.40

自引率

6.50%

发文量

254

审稿时长

3-8 weeks

期刊介绍： Since the first application of liver transplantation in a clinical situation was reported more than twenty years ago, there has been a great deal of growth in this field and more is anticipated. As an official publication of the AASLD, Liver Transplantation delivers current, peer-reviewed articles on liver transplantation, liver surgery, and chronic liver disease — the information necessary to keep abreast of this evolving specialty.