LIVER TRANSPLANT FOLLOWING BARIATRIC SURGERY: A MINI REVIEW

Background: As obesity prevalence has been increasing dramatically in the last decades, bariatric surgery is on the rise as an effective and feasible option to treat metabolic diseases related to overweight. One rare, but potentially fatal, complication of bariatric surgery is hepatic failure requiring rescue liver transplantation. Materials and Methods: Following the criteria of the PRISMA statement, a literature search was conducted focusing on papers concerning patients who underwent liver transplantation for hepatic failure following bariatric surgery. Due to the rarity of the described condition, both retrospective studies and case reports were included in this mini-review. Results: Literature review was performed on PubMed, Embase and Med- line, using (“liver transplantation” OR “liver graft”) AND (“bariatric sur- gery” OR “obesity surgery” OR “metabolic surgery”) as search terms. This led to the identification of 145 papers. We restricted the search to humans and english language articles resulting in 101 eligible articles to review. Title and abstract revision led to the identification of 14 papers for full text analysis. Cross-reference check provided 4 more articles to review. After final full text review, 6 papers, of which 2 were case reports and 4 case series, were included in this study. The timeframe between bariatric sur- gery and liver transplant varied between bariatric surgery techniques, ranging from 7 months to 25 years: jejunoileal bypass had a longer latency of hepatic failure, while biliopancreatic diversion, long limb gastric bypass and biliointestinal bypass showed a more rapid decay of liver function. Out of 24 patients listed for liver transplant, 3 died on waiting list and 1 was still on transplant list at the time of publication. Conclusions: Liver failure following bariatric surgery is an extremely serious condition, that can occur in both sub-acute and chronic setting. Although rare, its real incidence is not known and probably underreported in literature. Due to the worldwide spread of bariatric surgery, our goal is to highlight the importance of early recognition of liver failure in those patients