同时肝移植和袖胃切除术提供持久的体重减轻，改善代谢综合征和减少异体移植脂肪变性

IF 26.8 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Journal of Hepatology Pub Date : 2025-03-13 DOI:10.1016/j.jhep.2025.02.030

Ellen L. Larson, Samia D. Ellias, Daniel J. Blezek, Jason Klug, Robert P. Hartman, Nickie Francisco Ziller, Heather Bamlet, Shennen A. Mao, Dana K. Perry, Induja R. Nimma, Dilhana Badurdeen, Liu Yang, Michael D. Leise, Kymberly D. Watt, Tayyab S. Diwan, Timucin Taner, Charles D. Rosen, Enrique F. Elli, James A. Madura, Caroline C. Jadlowiec, Julie K. Heimbach

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引用次数: 0

摘要

背景和目的在肝移植（LT）候选者中，肥胖和代谢综合征（MetS）的患病率正在上升，其中许多人患有代谢相关脂肪变性肝病（MASLD）。LT后，未经治疗的肥胖常引起复发性MASLD。我们用肝移植和同步袖胃切除术（LTSG）治疗肥胖患者，旨在确定对移植后肥胖、MetS和复发性MASLD的长期影响。方法一项多中心回顾性队列研究分析了采用单一临床方案接受LTSG的患者（n=72）和BMI为30的单纯接受LTSG治疗MASLD的患者（n=185）。LTSG的随访时间为4-153个月（中位41个月），lt的随访时间为12-161个月（中位75个月）。结果包括死亡率、移植物损失、BMI、MetS成分、异体移植物脂肪变性和纤维化。结果两组患者死亡率和移植物损失无显著性差异。ltsg后患者8年糖尿病患病率显著降低（p < 0.05）；高血压由61.1%降至35.8% （p<0.01）。LTSG患者的平均起始BMI为45.5，与基线相比，9年的体重明显减轻（p<0.001）。单独使用lt的患者，平均起始BMI为34.0，BMI或糖尿病没有明显变化。同种异体移植脂肪变性的发生在LTSG患者中明显低于LT患者（p=0.004）。术后3-10年LTSG与LT患者的纤维化患病率降低；虽然没有统计学意义，但相对风险比为0.46 （p=0.09）。1例LTSG患者胃袖漏；一个需要裂孔疝修补。重度胃食管反流发生率为11.1%；危险因素包括先前存在的糖尿病和反流。结论：与单纯肝移植相比，sltsg可以持续减轻体重，缓解糖尿病和高血压，减少脂肪变性和纤维化的复发。它不会增加死亡率或移植物损失。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Simultaneous liver transplant and sleeve gastrectomy provides durable weight loss, improves metabolic syndrome and reduces allograft steatosis

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Simultaneous liver transplant and sleeve gastrectomy provides durable weight loss, improves metabolic syndrome and reduces allograft steatosis

Background and Aims

The prevalence of obesity and metabolic syndrome (MetS) is rising among liver transplant (LT) candidates, many of whom have Metabolic-Associated Steatotic Liver Disease (MASLD). Following LT, untreated obesity often causes recurrent MASLD. We treated patients with obesity with LT and concurrent sleeve gastrectomy (LTSG), aiming to determine long-term impact on obesity, MetS and recurrent MASLD after transplantation.

Methods

A multicenter retrospective cohort study analyzed patients undergoing LTSG using a single clinical protocol (n=72), and patients with BMI >30 who underwent LT alone for MASLD (n=185). Follow-up duration was 4-153 (median 41) months for LTSG and 12-161 (median 75) months for LT. Outcomes included mortality, graft loss, BMI, MetS components, allograft steatosis and fibrosis.

Results

Mortality and graft loss were not significantly different between LT and LTSG patients. Post-LTSG patients had significantly lower prevalence of diabetes for >8 years (p<0.05); hypertension decreased from 61.1% to 35.8% (p<0.01). LTSG patients, with average starting BMI of 45.5, had significant weight loss compared to baseline for >9 years (p<0.001). LT-alone patients, average starting BMI 34.0, experienced no significant change in BMI or diabetes. Development of allograft steatosis was significantly lower in LTSG vs LT patients (p=0.004). Fibrosis prevalence was reduced in LTSG vs LT patients 3-10 years postoperatively; although not statically significant, relative risk ratio was 0.46 (p=0.09). One LTSG patient had a gastric sleeve leak; one required hiatal hernia repair. Severe GERD occurred in 11.1% of LTSG patients; risk factors included pre-existing diabetes and GERD.

Conclusions

LTSG results in sustained weight loss, resolution of diabetes and hypertension, and reduced recurrence of steatosis and possibly fibrosis compared to LT alone. It confers no increase in mortality or graft loss.

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来源期刊

Journal of Hepatology 医学-胃肠肝病学

CiteScore

46.10

自引率

4.30%

发文量

2325

审稿时长

30 days

期刊介绍： The Journal of Hepatology is the official publication of the European Association for the Study of the Liver (EASL). It is dedicated to presenting clinical and basic research in the field of hepatology through original papers, reviews, case reports, and letters to the Editor. The Journal is published in English and may consider supplements that pass an editorial review.