Sleeve gastrectomy after liver transplantation: results of a 5-year follow-up.

BACKGROUND
Severe obesity and metabolic syndrome are common long-term complications after liver transplantation (LT). Metabolic bariatric surgery (MBS) is the essential treatment for severe obesity with laparoscopic sleeve gastrectomy (SG) being the most commonly performed procedure.


METHODS
This is a retrospective analysis of all LT patients who underwent MBS between January 2006 and December 2020 in a single tertiary center.


RESULTS
During the study period, a total of 226 LTs were performed. Four patients (1.8%) underwent SG following LT. Time interval from LT to SG ranged 11-72 months. The median Body Mass Index (BMI) before LT and SG was 38.8(±6.5) and 41.8(±2.7) kg/m2, respectively. All patients suffered from type II diabetes mellitus (T2DM) with a median A1c level of 5.9% (±1) under medications. All patients were consuming immunosuppressants perioperatively. All surgeries were approached laparoscopically, the median operative time was 65.5 minutes (±47.6), there were no intra-operative complications, and no conversions to open surgery. There were no early (30-day) major complications. The median length of stay was 3.5 days (±3.6). The median range of follow-up was 61.6 months (±18.2), there were no late (>30 day) complications. The median BMI at 24, and 60 months was 29.61(±3.9) and 31.10(±2.6) kg/m2, respectively. The median percentage of total weight loss at 24, and 60 months was 29.18 (±5.2) and 28.87(±3.7), respectively. The median percentage of excess weight loss at 24 and 60 months was 60.5% (±13) and 58.57% (±11.7), respectively. Three patients had T2DM resolution.


CONCLUSIONS
SG following LT is associated with low perioperative morbidity and satisfactory long-term results.