Bariatric Surgery in Liver Transplant Patients: Weighing the Evidence

Excerpt

In developed nations, physicians must modify their practices in order to provide good medical care to an increasing number of patients who suffer from obesity [1]. Transplant surgeons have especially struggled to adapt their practices as an increasing number of obese patients compete for a scarce supply of donor organs [2]. Generally, patients are considered transplant candidates if they have a reasonable chance of surviving for 5 years following surgery. Patient selection is complicated when this principle is combined with the paradoxical approach of prioritizing patients with the greatest severity of liver disease [3]. Under these circumstances, the survival statistics for obese patients has been very disappointing [4, 5]. Far more obese patients suffer from early death and donor graft loss than other transplant recipients. Early deaths are clearly caused by complications due to obesity. The death rate due to cardiovascular and pulmonary disease and complications of insulin resistance mirrors the higher rate of medical problems in obese patients in general. …