Surgical Combination Shows Promise for Obese Patients with End-Stage Liver Failure скачать в хорошем качестве

Surgical Combination Shows Promise for Obese Patients with End-Stage Liver Failure

Combining bariatric surgery with liver transplant shows promise for patients with medically-complicated obesity and end-stage liver failure, Mayo Clinic researchers recently reported in the American Journal of Transplantation. In a first-of-its-kind study led by Mayo Clinic liver transplant surgeon Julie Heimbach, M.D., the research seeks to identify solutions for a growing population of patients whose liver failure is either caused by or complicated by obesity. The prevalence of obesity in the U.S. is currently estimated to be approximately 35%. The obesity epidemic has also impacted patients with end-stage liver disease, and may be either the primary cause of their liver disease, or at least a contributing factor. Recent evidence has shown that nonalcoholic steatohepatitis (NASH) is the most rapidly rising indication for liver transplant in the U.S. and is predicted to become the most common indication. While obese patients can be transplanted with similar outcomes to non-obese patients in the short-term, the long-term impact of obesity on liver transplant patients post-transplant (including recurrence of NASH and hepatitis C) is becoming increasingly evident. Additionally, obesity is associated with diabetes, heart disease, and cancer which are leading causes of morbidity and mortality post-transplant. Obese patients are required to lose weight prior to transplant, and long-term outcomes are better if they can keep the weight off. Those who are successful with weight loss can proceed with a liver transplant as soon as a donor organ is available. Patients who are unsuccessful at weight loss are often denied for transplant until they lose weight. Mayo Clinic has devised a program which offers a combined liver transplant with sleeve gastrectomy for obese patients with end-stage liver disease who were unsuccessful in attaining weight loss in an aggressive noninvasive pre-transplant weight loss protocol. A sleeve gastrectomy is a bariatric weight loss procedure that is less complex than other gastric bypass procedures, and provides better absorption which is thought to be better for maintaining post-transplant immunosuppression levels. In a study of eight patients who met the criteria for the combined procedure, all of the patients and allografts survived. All of the patients had significant weight loss and none require insulin. None of the patients have had recurrence of liver disease. It did not increase operative time, and also prevented these patients from requiring two surgeries to complete the same goal. Dr. Heimbach describes the study and the procedure in this video .