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.