Back to 2025 Abstracts
90 DAY OUTCOMES OF BARIATRIC SURGERY IN CIRRHOSIS AND PORTAL HYPERTENSION AS A BRIDGE TO LIVER TRANSPLANTATION
Timothy Trestrail, William Scola
*, Talia R. Arcieri, Patrick R. Wang, David Goldberg, Mahmoud Mahfouz, Onur C. Kutlu
General Surgery , University of Miami - Jackson Memorial Hospital, Miami, FL
Introduction: Metabolic dysfunction-associated steatohepatitis (MASH) is progressively becoming the leading cause of end stage liver disease and liver transplantation. 12.5% of liver transplant recipients are morbidly obese. Many patients are unsuitable for transplantation due to obesity. Despite the evidence, bariatric surgery is rarely performed in this group of patients. We present our pre-operative optimization protocol, surgical technique, and outcomes in patients with cirrhosis and portal hypertension.
Methods: Patients who underwent bariatric surgery with Model for End-Stage Liver Disease (MELD) scores greater than 15, with significant portal hypertension, and who were liver transplantation candidates were identified and reviewed.
Results: Six patients were included. All were male. Median age was 56 (42-63) years, mean body mass index was 42.7, mean MELD score was 16.3 (15-18), mean Child-Pugh class was B (score 7.2, 7-8), calculated Vocal-Penn risk of 30-day mortality was 5.5% and 90-day decompensation was 25.3%. Three patients had previous esophageal variceal bleeding, one had a previous sleeve gastrectomy.
All patients were optimized by hepatology preoperatively. Five patients underwent laparoscopic sleeve gastrectomy (SG), and one patient underwent a sleeve to gastric bypass. Mean blood loss was 150 milliliters (20-450), median hospital stay was 3 days (2-4). 30-day and 90-day mortality and 90-day decompensation rates were 0%.
Conclusion: Despite the data on weight loss for prevention of disease progression in the native liver, and disease recurrence in the transplant patient, bariatric surgery is not being widely utilized. The timing of surgery is an area of discussion. Our findings support the literature, suggesting in pre-transplant bariatric surgery, there are low bariatric surgery related complication rates and peri-transplantation morbidity.
Back to 2025 Abstracts
