He wears his Liver on his Sleeve
AAPA ePoster library. Hall E. 05/17/17; 180512; 139
Elizabeth Hall
Elizabeth Hall
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Abstract
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Case Presentation A 48 year old gentleman with NASH-related cirrhosis (initial MELD 19) with concomitant morbid obesity (BMI 50) presented for evaluation for liver transplant. Given his medically complicated obesity, the patient was also evaluated for bariatric surgery at the time of transplant. He was successful with lifestyle modifications and had approximately 40lbs weight loss through the bariatric program, decreasing his BMI to 47.3 over six months. Because of this, he was felt to be a candidate. He underwent a combined DCD orthotropic liver transplant (MELD 23) and gastric sleeve procedure at time of transplant. The allograft biliary reconstruction was performed with standard duct to duct anastomosis. His post-transplant was notable for ERCP with stent placement for biliary stricture twice, as well as pyloric stenosis requiring endoscopic dilation. He had a favorable post-transplant course in regards to his weight loss. His weight on surgery date was 138.6kg, and his weight three months postoperative was 102.3kg, which is approximately 80lbs weight loss in three months. He continues to ambulate daily for cardiovascular exercise with initial weight limitations post operatively. From a dietary standpoint, he has three meals per day with two snacks, with a focus on protein at meals and snacks, and avoidance of starches. Additionally, he maintains on daily multivitamin with iron, and calcium supplements. The patient is encouraged a close relationship with the Bariatric dietician, in addition to standard appointments with Transplant Hepatology and Bariatric Surgery. Discussion Traditionally muscle wasting and anorexia are most commonly associated with ESLD; however, with obesity growing in the United States, NASH is becoming one of the primary indications for liver transplant. Patients who are felt to be successful transplant candidates and successful with bariatric programs, may be candidates for possible combined bariatric surgery and transplant, particularly younger patients who otherwise relatively healthy. Post-operative complications seen from gastric sleeve include leak from gastric staple line resulting in prolonged hospitalizations and reoperations, less ideal for an immunocompromised patient. Additionally, close monitoring is needed to ensure weight loss does not occur too rapidly. The concerns for obese patients who undergo liver transplant alone have an increased risk of weight gain related to steroid in...
Case Presentation A 48 year old gentleman with NASH-related cirrhosis (initial MELD 19) with concomitant morbid obesity (BMI 50) presented for evaluation for liver transplant. Given his medically complicated obesity, the patient was also evaluated for bariatric surgery at the time of transplant. He was successful with lifestyle modifications and had approximately 40lbs weight loss through the bariatric program, decreasing his BMI to 47.3 over six months. Because of this, he was felt to be a candidate. He underwent a combined DCD orthotropic liver transplant (MELD 23) and gastric sleeve procedure at time of transplant. The allograft biliary reconstruction was performed with standard duct to duct anastomosis. His post-transplant was notable for ERCP with stent placement for biliary stricture twice, as well as pyloric stenosis requiring endoscopic dilation. He had a favorable post-transplant course in regards to his weight loss. His weight on surgery date was 138.6kg, and his weight three months postoperative was 102.3kg, which is approximately 80lbs weight loss in three months. He continues to ambulate daily for cardiovascular exercise with initial weight limitations post operatively. From a dietary standpoint, he has three meals per day with two snacks, with a focus on protein at meals and snacks, and avoidance of starches. Additionally, he maintains on daily multivitamin with iron, and calcium supplements. The patient is encouraged a close relationship with the Bariatric dietician, in addition to standard appointments with Transplant Hepatology and Bariatric Surgery. Discussion Traditionally muscle wasting and anorexia are most commonly associated with ESLD; however, with obesity growing in the United States, NASH is becoming one of the primary indications for liver transplant. Patients who are felt to be successful transplant candidates and successful with bariatric programs, may be candidates for possible combined bariatric surgery and transplant, particularly younger patients who otherwise relatively healthy. Post-operative complications seen from gastric sleeve include leak from gastric staple line resulting in prolonged hospitalizations and reoperations, less ideal for an immunocompromised patient. Additionally, close monitoring is needed to ensure weight loss does not occur too rapidly. The concerns for obese patients who undergo liver transplant alone have an increased risk of weight gain related to steroid in...
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