Innovative Approach Offering Pathway to Liver Transplant for Patients Struggling to Lose Weight

Dec 13, 2017 | Mayo Clinic Transplant Staff | @mayoclinictransplantstaff

Approximately 19 million Americans have severe obesity, which is defined as a body mass index (BMI) over 40. Excess body fat can lead to cirrhosis and eventual liver failure, similar to the effects of long-term heavy drinking. This condition is called nonalcoholic steatohepatitis (NASH). Some patients with cirrhosis and liver failure will need a lifesaving liver transplant. The incidence of NASH is increasing, and today, it’s the second most common reason for liver transplant.

Many transplant centers, including Mayo Clinic, require weight loss to a set BMI before a liver transplant. In highly selected cases where weight loss is not working, Mayo Clinic surgeons are offering a simultaneous liver transplant and weight loss surgery using sleeve gastrectomy. Here are three things to know about this innovative option.

Serves patient population with limited options. Mayo Clinic came up with the idea to combine a liver transplant and gastric sleeve into one operation because of a growing need for treatment options among this patient population. Obesity-related liver disease is the most common liver disease in the United States today. Unfortunately, these patients are often left with few options for treating their liver failure and obesity. The simultaneous liver transplant and gastric sleeve is dramatically changing the future for these patients as both problems can be addressed at the same time.
Gastric sleeve is not the same as gastric bypass. A gastric sleeve works by restricting the amount of food a person can eat. Gastric bypass both restricts the amount of food a person can eat and creates malabsorption of food and medications, which would be problematic post-transplant due to the need for immunosuppressant medications. With gastric sleeve, the patient becomes full quickly when eating, which can help change dietary habits. Following transplant, weight loss can occur at a healthy pace. Over time, sustained weight loss helps maintain the well-being of the new liver and reduces other problems associated with excess weight, such as diabetes and high blood pressure.
Similar recovery. Recovering from the simultaneous liver transplant and gastric sleeve is not much different than recovering from a liver transplant alone. By combining the procedures, patients are able to avoid two separate hospital stays and two separate recoveries.

Scott received a combination liver transplant and sleeve gastrectomy at Mayo Clinic. This is his story.