Bariatric Surgery Before, During, and After Liver Transplantation: A Systematic Review and Meta-Analysis

Abstract Morbid obesity is considered a relative contraindication for liver transplantation (LTX) due to increased risk of complications. The aim of this study was to investigate the role of bariatric surgery before, during, and after LTX. A systematic review of MEDLINE, EMBASE, CENTRAL, and PubMed databases was performed for studies investigating bariatric surgery in patients before, during, or after LTX. Random-effects meta-analysis of proportions was used to calculate pooled effect estimates. 187 patients underwent bariatric surgery before LTX (8 studies). After surgery, 82% (95%CI, 62-97%) of patients were successfully listed for LTX and 70% (95%CI, 40-93%) successfully received LTX. The 30-day mortality rate was 0%. The graft survival rate after 1-year was 70% (95%CI, 30-99%). 30-day minor and major complications rate was 4% and 1%, respectively. 32 patients underwent bariatric surgery during LTX (2 studies). The 30-day mortality rate after surgery was 0% and 1-year graft survival was 100%. 64 patients underwent bariatric surgery after LTX (9 studies). The 30-day mortality was 0%, but 5 deaths occurred beyond 30 days (7.8%). Bariatric surgery may be safe and feasible as a bridge to LTX for patients who would otherwise be ineligible and post-LTX patients for weight loss.