Liver transplant with sleeve gastrectomy delivers durable weight loss, improves metabolic syndrome

Simultaneous liver transplantation (LT) and sleeve gastrectomy (SG) is effective in sustaining weight loss, managing diabetes and hypertension, and preventing recurrence of steatosis and possibly fibrosis compared with LT alone, suggests a study.

“It confers no increase in mortality or graft loss,” the authors said.

Patients undergoing LTSG were analysed using a single clinical protocol (n=72) and patients with BMI >30 kg/m² who underwent LT alone for metabolic dysfunction-associated steatotic liver disease (MASLD; n=185) in a multicentre retrospective cohort study. Follow-up duration was 4‒153 months for LTSG and 12‒161 months for LT.

No significant between-group difference was noted in mortality and graft loss. Patients in the LTSG arm had a significantly lower prevalence of diabetes than those in the LT alone arm after 8 years of follow-up (p<0.05), as well as reduced hypertension from 61.1 percent to 35.8 percent (p<0.01).

Patients who underwent LTSG had significant weight loss compared to baseline for >9 years (p<0.001), but no significant change occurred for those who underwent LT alone.

Furthermore, the incidence of allograft steatosis was significantly lower in the LTSG arm than the LT alone arm (p=0.004), as was the prevalence of fibrosis 3‒10 years postoperatively (relative risk ratio, 0.46; p=0.09).

Notably, a gastric sleeve leak occurred in one patient in the LTSG group, and another required hiatal hernia repair. Severe gastroesophageal reflux disease (GERD) occurred in 11.1 percent of patients in the LTSG group and correlated with pre-existing diabetes and GERD.