Efficacy and safety of simultaneous sleeve gastrectomy and liver transplantation compared to liver transplantation alone in obese liver transplanted patients: a meta-analysis

Introduction

The morbid obesity in liver transplantation (LT) candidates is increasing. In patients failing to achieve weight loss following diet and pharmacological therapies, sleeve gastrectomy (SG) could be considered. The ideal time to perform SG remains a critical issue.

Aim

This meta-analysis compares, body mass index (BMI) change from baseline and mortality, 2-years after LT in obese who underwent simultaneous SG and LT compared to LT alone.Methods. A literature search of PubMed database was conducted up to June, 2025. A test of homogeneity (Cochran’s Q test) was conducted to evaluate the degree of variability across selected studies. For BMI change, meta-analyses were conducted using Cohen’s d as the effect size. All analyses were performed using a significance level of α =0,05. Statistical analyses were carried out using IBM SPSS Statistics version 30.

Results

Among the 180 articles selected, 3 were considered eligible. Overall, 348 patients were enrolled; 99 and 249 underwent LT+SG and LT alone respectively. A significantly higher BMI decrease from baseline in LT+SG compared to LT alone group 2-years after LT (p <0,001) was reported in the 2/3 studies eligible (Fig. 1). No significant differences in mortality were recorded between groups (p =0,478) (Fig. 2).

Conclusions

Simultaneous SG and LT compared to LT alone, resulted in a greater BMI reduction, without increasing the risk of mortality 2 years after LT. Further studies are needed to confirm these results and to assess the benefit of BMI decrease in preventing/treating the recurrence of metabolic associated steatotic liver disease (MASLD).