How best to combine liver transplantation and bariatric surgery?-Results from a global, web-based survey.
Roux-en-Y gastric bypass
bariatric surgery
liver transplant
metabolic-associated fatty liver disease
non-alcoholic fatty liver disease
non-alcoholic steatohepatitis
obesity
sleeve gastrectomy
survey
Journal
Liver international : official journal of the International Association for the Study of the Liver
ISSN: 1478-3231
Titre abrégé: Liver Int
Pays: United States
ID NLM: 101160857
Informations de publication
Date de publication:
11 Dec 2023
11 Dec 2023
Historique:
revised:
20
10
2023
received:
15
08
2023
accepted:
31
10
2023
medline:
12
12
2023
pubmed:
12
12
2023
entrez:
12
12
2023
Statut:
aheadofprint
Résumé
Obesity is a growing healthcare challenge worldwide and a significant risk factor for liver failure as seen with non-alcoholic steatohepatitis (NASH). Combining metabolic-bariatric surgery (MBS) with liver transplantation (LT) appears as attractive strategy to treat both, the underlying liver disease and obesity. However, there is an ongoing debate on best timing and patient selection. This survey was designed to explore the current treatment practice for patients with NASH and obesity worldwide. A web-based survey was conducted in 2022 among bariatric and LT surgeons, and hepatologists from Europe, North and South America and Asia. The survey completion rate was 74% (145/196). The average respondents were 41-50 years (38%), male (82.1%) and had >20 years of clinical experience (42.1%). Centres with a high LT-caseload for NASH were mainly located in the USA and United Kingdom. Almost 30% have already performed a combination of LT with MBS and 49% plan to do it. A majority of bariatric surgeons prefer MBS before LT (77.2%), whereas most of LT surgeons (52%) would perform MBS during LT. Most respondents (n = 114; 80%) favour sleeve gastrectomy over other bariatric techniques. One third (n = 42; 29.4%) has an established protocol regarding MBS for LT candidates. The most experienced centres doing LT for NASH are in the USA and United Kingdom with growing awareness worldwide. Overall, a combination of MBS and LT has already been performed by a third of respondents. Sleeve gastrectomy is the bariatric technique of choice-preferably performed either before or during LT.
Sections du résumé
BACKGROUND AND AIMS
OBJECTIVE
Obesity is a growing healthcare challenge worldwide and a significant risk factor for liver failure as seen with non-alcoholic steatohepatitis (NASH). Combining metabolic-bariatric surgery (MBS) with liver transplantation (LT) appears as attractive strategy to treat both, the underlying liver disease and obesity. However, there is an ongoing debate on best timing and patient selection. This survey was designed to explore the current treatment practice for patients with NASH and obesity worldwide.
METHODS
METHODS
A web-based survey was conducted in 2022 among bariatric and LT surgeons, and hepatologists from Europe, North and South America and Asia.
RESULTS
RESULTS
The survey completion rate was 74% (145/196). The average respondents were 41-50 years (38%), male (82.1%) and had >20 years of clinical experience (42.1%). Centres with a high LT-caseload for NASH were mainly located in the USA and United Kingdom. Almost 30% have already performed a combination of LT with MBS and 49% plan to do it. A majority of bariatric surgeons prefer MBS before LT (77.2%), whereas most of LT surgeons (52%) would perform MBS during LT. Most respondents (n = 114; 80%) favour sleeve gastrectomy over other bariatric techniques. One third (n = 42; 29.4%) has an established protocol regarding MBS for LT candidates.
CONCLUSION
CONCLUSIONS
The most experienced centres doing LT for NASH are in the USA and United Kingdom with growing awareness worldwide. Overall, a combination of MBS and LT has already been performed by a third of respondents. Sleeve gastrectomy is the bariatric technique of choice-preferably performed either before or during LT.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Références
NCD Countdown 2030 collaborators. NCD countdown 2030: worldwide trends in non-communicable disease mortality and progress towards sustainable development goal target 3.4. Lancet. 2018;392:1072-1088. doi:10.1016/S0140-6736(18)31992-5
Aminian A, Kashyap SR, Wolski KE, et al. Patient-reported outcomes after metabolic surgery versus medical therapy for diabetes: insights from the STAMPEDE randomized trial. Ann Surg. 2021;274:524-532. doi:10.1097/SLA.0000000000005003
Mingrone G, Panunzi S, De Gaetano A, et al. Metabolic surgery versus conventional medical therapy in patients with type 2 diabetes: 10-year follow-up of an open-label, single-centre, randomised controlled trial. Lancet. 2021;397:293-304. doi:10.1016/S0140-6736(20)32649-0
Huang S, Lan Y, Zhang C, Zhang J, Zhou Z. The early effects of bariatric surgery on cardiac structure and function: a systematic review and meta-analysis. Obes Surg. 2023;33:453-468. doi:10.1007/s11695-022-06366-5
Goldstone AP, Miras AD, Scholtz S, et al. Link between increased satiety gut hormones and reduced food reward after gastric bypass surgery for obesity. J Clin Endocrinol Metab. 2016;101:599-609. doi:10.1210/jc.2015-2665
Sasaki A, Nitta H, Otsuka K, et al. Bariatric surgery and non-alcoholic fatty liver disease: current and potential future treatments. Front Endocrinol. 2014;5:164. doi:10.3389/fendo.2014.00164
Younossi ZM, Golabi P, Paik JM, Henry A, Van Dongen C, Henry L. The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): a systematic review. Hepatology. 2023;77:1335-1347. doi:10.1097/HEP.0000000000000004
Riazi K, Azhari H, Charette JH, et al. The prevalence and incidence of NAFLD worldwide: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2022;7:851-861. doi:10.1016/S2468-1253(22)00165-0
Murag S, Ahmed A, Kim D. Recent epidemiology of nonalcoholic fatty liver disease. Gut Liver. 2021;15:206-216. doi:10.5009/gnl20127
Lin S, Huang J, Wang M, et al. Comparison of MAFLD and NAFLD diagnostic criteria in real world. Liver Int. 2020;40:2082-2089. doi:10.1111/liv.14548
Eslam M, Newsome PN, Sarin SK, et al. A new definition for metabolic dysfunction-associated fatty liver disease: an international expert consensus statement. J Hepatol. 2020;73:202-209. doi:10.1016/j.jhep.2020.03.039
Czigany Z, Kramp W, Bednarsch J, et al. Myosteatosis to predict inferior perioperative outcome in patients undergoing orthotopic liver transplantation. Am J Transplant. 2020;20:493-503. doi:10.1111/ajt.15577
Adam R, Karam V, Cailliez V, et al. Annual report of the European liver transplant registry (ELTR)-50-year evolution of liver transplantation. Transplant Int. 2018;2018(31):1293-1317. doi:10.1111/tri.13358
Nagai S, Collins K, Chau LC, et al. Increased risk of death in first year after liver transplantation among patients with nonalcoholic Steatohepatitis vs liver disease of other etiologies. Clin Gastroenterol Hepatol. 2019;17:2759-2768.e5. doi:10.1016/j.cgh.2019.04.033
Burra P, Becchetti C, Germani G. NAFLD and liver transplantation: disease burden, current management and future challenges. JHEP Rep. 2020;2:100192. doi:10.1016/j.jhepr.2020.100192
Saeed N, Glass L, Sharma P, Shannon C, Sonnenday CJ, Tincopa MA. Incidence and risks for nonalcoholic fatty liver disease and Steatohepatitis post-liver transplant: systematic review and meta-analysis. Transplantation. 2019;103:e345-e354. doi:10.1097/TP.0000000000002916
Verrastro O, Panunzi S, Castagneto-Gissey L, et al. Bariatric-metabolic surgery versus lifestyle intervention plus best medical care in non-alcoholic steatohepatitis (BRAVES): a multicentre, open-label, randomised trial. Lancet. 2023;401:1786-1797. doi:10.1016/S0140-6736(23)00634-7
Muller X, Marcon F, Sapisochin G, et al. Defining benchmarks in liver transplantation: a multicenter outcome analysis determining best achievable results. Ann Surg. 2018;267:419-425. doi:10.1097/SLA.0000000000002477
Gero D, Raptis DA, Vleeschouwers W, et al. Defining global benchmarks in bariatric surgery: a retrospective multicenter analysis of minimally invasive Roux-en-Y gastric bypass and sleeve gastrectomy. Ann Surg. 2019;270:859-867. doi:10.1097/SLA.0000000000003512
Abbassi F, Gero D, Muller X, et al. Novel benchmark values for redo liver transplantation: does the outcome justify the effort? Ann Surg. 2022;276:860-867. doi:10.1097/SLA.0000000000005634
World Obesity Atlas 2023. World Obesity Federation n.d. https://www.worldobesity.org/resources/resource-library/world-obesity-atlas-2023. Accessed April 18, 2023
Colquitt JL, Pickett K, Loveman E, Frampton GK. Surgery for weight loss in adults. Cochrane Database Syst Rev. 2014;2014:CD003641. doi:10.1002/14651858.CD003641.pub4
Billeter AT, Reiners B, Seide SE, et al. Comparative effectiveness of medical treatment vs. metabolic surgery for histologically proven non-alcoholic steatohepatitis and fibrosis: a matched network meta-analysis. Hepatobiliary Surg Nutr. 2022;11:696-708. doi:10.21037/hbsn-21-5
Topart P. Obesity surgery: which procedure should we choose and why? J Visc Surg. 2023;160:S30-S37. doi:10.1016/j.jviscsurg.2022.12.010
Clapp B, Corbett J, Jordan M, Portela R, Ghanem OM. Single-anastomosis duodenoileal bypass with sleeve in the United States: a first comparative safety analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. Surg Obes Relat Dis. 2023;19:11-17. doi:10.1016/j.soard.2022.08.016
Battistella S, D'Arcangelo F, Grasso M, et al. Liver transplantation for non-alcoholic fatty liver disease: indications and post-transplant management. Clin Mol Hepatol. 2023;29:S286-S301. doi:10.3350/cmh.2022.0392
Bai J, Jia Z, Chen Y, Li Y, Zheng S, Duan Z. Bariatric surgery is effective and safe for obese patients with compensated cirrhosis: a systematic review and meta-analysis. World J Surg. 2022;46:1122-1133. doi:10.1007/s00268-021-06382-z
Fakhry TK, Mhaskar R, Schwitalla T, Muradova E, Gonzalvo JP, Murr MM. Bariatric surgery improves nonalcoholic fatty liver disease: a contemporary systematic review and meta-analysis. Surg Obes Relat Dis. 2019;15:502-511. doi:10.1016/j.soard.2018.12.002
Zhou H, Luo P, Li P, et al. Bariatric surgery improves nonalcoholic fatty liver disease: systematic review and meta-analysis. Obes Surg. 2022;32:1872-1883. doi:10.1007/s11695-022-06011-1
de Almeida SR, Rocha PRS, Sanches MD, et al. Roux-en-Y gastric bypass improves the nonalcoholic steatohepatitis (NASH) of morbid obesity. Obes Surg. 2006;16:270-278. doi:10.1381/096089206776116462
Vuppalanchi R, McCabe ME, Tandra SR, et al. Safety and efficacy of bariatric surgery in cirrhosis patients with extreme obesity. Ann Surg. 2022;275:e174-e180. doi:10.1097/SLA.0000000000003891
Christakoudi S, Tsilidis KK, Muller DC, et al. A Body Shape Index (ABSI) achieves better mortality risk stratification than alternative indices of abdominal obesity: results from a large European cohort. Sci Rep. 2020;10:14541. doi:10.1038/s41598-020-71302-5
Hill JH, Solt C, Foster MT. Obesity associated disease risk: the role of inherent differences and location of adipose depots. Horm Mol Biol Clin Invest. 2018;33:20180012. doi:10.1515/hmbci-2018-0012
Berardi G, Ratti F, Sposito C, et al. Model to predict major complications following liver resection for HCC in patients with metabolic syndrome. Hepatology. 2023;77:1527-1539. doi:10.1097/HEP.0000000000000027
Rajadurai VA, Nathan E, Pontré JC, Mcelhinney B, Karthigasu KA, Hart R. The effect of obesity on cost of total laparoscopic hysterectomy. Aust N Z J Obstet Gynaecol. 2022;62:566-573. doi:10.1111/ajo.13520
Chen W-Z, Chen X-D, Ma L-L, et al. Impact of visceral obesity and sarcopenia on short-term outcomes after colorectal cancer surgery. Dig Dis Sci. 2018;63:1620-1630. doi:10.1007/s10620-018-5019-2
Shafaat O, Liu Y, Jackson KR, et al. Association between abdominal CT measurements of body composition before deceased donor liver transplant with Posttransplant outcomes. Radiology. 2023;306:e212403. doi:10.1148/radiol.212403
Wall A, Lee GH, Maldonado J, Magnus D. Medical contraindications to transplant listing in the USA: a Survey of Adult and Pediatric Heart, Kidney, Liver, and Lung Programs. World J Surg. 2019;43:2300-2308. doi:10.1007/s00268-019-05030-x
European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu. EASL Clinical Practice Guidelines: liver transplantation. J Hepatol. 2016;64:433-485. doi:10.1016/j.jhep.2015.10.006
Martin P, DiMartini A, Feng S, Brown R, Fallon M. Evaluation for liver transplantation in adults: 2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation. Hepatology. 2014;59:1144-1165. doi:10.1002/hep.26972
Soma D, Park Y, Mihaylov P, et al. Liver transplantation in recipients with class III obesity: Posttransplant outcomes and weight gain. Transplant Direct. 2022;8:e1242. doi:10.1097/TXD.0000000000001242
Conzen KD, Vachharajani N, Collins KM, et al. Morbid obesity in liver transplant recipients adversely affects longterm graft and patient survival in a single-institution analysis. HPB (Oxford). 2015;17:251-257. doi:10.1111/hpb.12340
Harrington CR, Levy P, Cabrera E, et al. Evolution of pretransplant cardiac risk factor burden and major adverse cardiovascular events in liver transplant recipients over time. Liver Transpl. 2023;29:581-590. doi:10.1097/LVT.0000000000000013
Vanwagner LB, Bhave M, Te HS, Feinglass J, Alvarez L, Rinella ME. Patients transplanted for nonalcoholic steatohepatitis are at increased risk for postoperative cardiovascular events. Hepatology. 2012;56:1741-1750. doi:10.1002/hep.25855
Nguyen VH, Le MH, Cheung RC, Nguyen MH. Differential clinical characteristics and mortality outcomes in persons with NAFLD and/or MAFLD. Clin Gastroenterol Hepatol. 2021;19:2172-2181.e6. doi:10.1016/j.cgh.2021.05.029
Steggerda JA, Mahendraraj K, Todo T, Noureddin M. Clinical considerations in the management of non-alcoholic steatohepatitis cirrhosis pre- and post-transplant: a multi-system challenge. World J Gastroenterol. 2020;26:4018-4035. doi:10.3748/wjg.v26.i28.4018
van Son J, Stam SP, Gomes-Neto AW, et al. Post-transplant obesity impacts long-term survival after liver transplantation. Metabolism. 2020;106:154204. doi:10.1016/j.metabol.2020.154204
Benmassaoud A, Deschenes M, Chen T, Ghali P, Sebastiani G. Optimizing patients with non-alcoholic fatty liver disease pre-transplant. Can Liver J. 2020;3:237-250. doi:10.3138/canlivj-2019-0025
Fatourou EM, Tsochatzis EA. Management of metabolic syndrome and cardiovascular risk after liver transplantation. Lancet Gastroenterol Hepatol. 2019;4:731-741. doi:10.1016/S2468-1253(19)30181-5
Duchini A, Brunson ME. Roux-en-Y gastric bypass for recurrent nonalcoholic steatohepatitis in liver transplant recipients with morbid obesity. Transplantation. 2001;72:156-159. doi:10.1097/00007890-200107150-00029
Addeo P, Cesaretti M, Anty R, Iannelli A. Liver transplantation for bariatric surgery-related liver failure: a systematic review of a rare condition. Surg Obes Relat Dis. 2019;15:1394-1401. doi:10.1016/j.soard.2019.06.002
Ahmed Z, Khan MA, Vazquez-Montesino LM, Ahmed A. Bariatric surgery, obesity and liver transplantation. Transl Gastroenterol Hepatol. 2022;7:25. doi:10.21037/tgh-2020-14
Bonner K, Heimbach JK. Obesity management in the liver transplant recipient: the role of bariatric surgery. Curr Opin Organ Transplant. 2018;23:244-249. doi:10.1097/MOT.0000000000000513
de Barros F, Cardoso Faleiro Uba PH. Liver transplantation and bariatric surgery: a new surgical reality: a systematic review of the best time for bariatric surgery. Updates Surg. 2021;73:1615-1622. doi:10.1007/s13304-021-01106-3
Diwan TS, Rice TC, Heimbach JK, Schauer DP. Liver Transplantation and Bariatric Surgery: timing and outcomes. Liver Transpl. 2018;24:1280-1287. doi:10.1002/lt.25303
Takata MC, Campos GM, Ciovica R, et al. Laparoscopic bariatric surgery improves candidacy in morbidly obese patients awaiting transplantation. Surg Obes Relat Dis. 2008;4:159-164; discussion 164-165. doi:10.1016/j.soard.2007.12.009
Lin MYC, Tavakol MM, Sarin A, et al. Laparoscopic sleeve gastrectomy is safe and efficacious for pretransplant candidates. Surg Obes Relat Dis. 2013;9:653-658. doi:10.1016/j.soard.2013.02.013
Bronswijk M, Jaekers J, Vanella G, Struyve M, Miserez M, van der Merwe S. Umbilical hernia repair in patients with cirrhosis: who, when and how to treat. Hernia. 2022;26:1447-1457. doi:10.1007/s10029-022-02617-7
Mehdorn AS, Moulla Y, Mehdorn M, et al. Bariatric surgery in liver cirrhosis. Front Surg. 2022;9:986297. doi:10.3389/fsurg.2022.986297
Castillo-Larios R, Gunturu NS, Elli EF. Outcomes of bariatric surgery before, during, and after solid organ transplantation. Obes Surg. 2022;32:3821-3829. doi:10.1007/s11695-022-06334-z
Gunturu NS, Castillo-Larios R, Bowers S, et al. Combined sleeve gastrectomy with liver transplant in patients with obesity: a feasibility study. Obes Surg. 2022;32:3600-3604. doi:10.1007/s11695-022-06289-1
Abu-Abeid A, Dvir N, Levi S, Dayan D. Sleeve gastrectomy after liver transplantation: results of a 5-year follow-up. Minerva Surg. 2022;78:254-260. doi:10.23736/S2724-5691.22.09672-1
Tariq N, Saharia A, Nwokedi U, et al. Combined liver transplantation and sleeve gastrectomy: report of a brief-interval staged approach. Liver Transpl. 2023;29:422-430. doi:10.1002/lt.26560
Singhal V, Dhampalwar S, Saigal S, et al. Successful outcome of bariatric surgery in living donor liver transplant recipients with multidisciplinary approach: a preliminary experience. J Clin Exp Hepatol. 2021;11:144-148. doi:10.1016/j.jceh.2020.05.008
Zaigham H, Enochsson L, Ottosson J, Regnér S. Laparoscopic transcystic common bile duct exploration versus transgastric endoscopic retrograde cholangiography during cholecystectomy after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2023;19:882-888. doi:10.1016/j.soard.2023.01.023