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Simultaneous living donor liver transplant with sleeve gastrectomy for metabolic syndrome and NASH-related ESLD—First report from India

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Abstract

Nonalcoholic steatohepatitis (NASH) with morbid obesity and metabolic syndrome is now a common cause of end-stage liver disease (ESLD). These patients are high-risk candidates for liver transplant, and require bariatric surgery to prevent recurrent disease in the new liver. Data reports bariatric surgery after transplant, which maybe difficult because of adhesions between the stomach and liver in living donor liver transplant (LDLT) recipient. We report the first case of combined LDLT with sleeve gastrectomy (SG) from India. A morbidly obese diabetic woman with NASH-related ESLD was planned for combined right lobe LDLT with open SG, in view of failed diet therapy, musculo-skeletal complaints, and restricted mobility. Postoperatively, with liver graft functioning adequately, bariatric diet restrictions resulted in maximum reduction of 25% weight, achieving a target BMI below 30 kg/m2 within 2 months, along with complete cure of diabetes and better ambulation. Thus, combination of LDLT and bariatric surgery in the same sitting is safe and effective in management of metabolic syndrome and associated NASH-related ESLD.

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Authors and Affiliations

  1. Department of HPB and Liver Transplant, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Achutrao Patwardhan Marg, Mumbai, 400 053, India

    Suneed Kumar, Kapildev Yadav, Swapnil Sharma, Shailesh Sable, Ashutosh Chauhan, Sorabh Kapoor, Vibha Varma & Vinay Kumaran

  2. Department of Metabolic and Bariatric Surgery, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Achutrao Patwardhan Marg, Mumbai, 400 053, India

    Nidhi Khandelwal & Jaydeep Palep

  3. Department of Neurosurgery, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Achutrao Patwardhan Marg, Mumbai, 400 053, India

    Abhaya Kumar

Authors
  1. Suneed Kumar
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  2. Nidhi Khandelwal
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  3. Abhaya Kumar
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  4. Kapildev Yadav
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  5. Swapnil Sharma
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  6. Shailesh Sable
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  7. Ashutosh Chauhan
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  8. Sorabh Kapoor
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  9. Vibha Varma
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  10. Jaydeep Palep
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  11. Vinay Kumaran
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Corresponding author

Correspondence to Vinay Kumaran.

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Conflict of interest

SK, NK, AK, KY, SS, SS, AC, SK, VV, JP, and VK declare that they have no conflicts of interest.

Ethical approval

All procedures performed in the study were in accordance with the ethical standards of the institution. Informed consent was obtained from the patient for publishing this study.

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Kumar, S., Khandelwal, N., Kumar, A. et al. Simultaneous living donor liver transplant with sleeve gastrectomy for metabolic syndrome and NASH-related ESLD—First report from India. Indian J Gastroenterol 36, 243–247 (2017). https://doi.org/10.1007/s12664-017-0753-5

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  • DOI: https://doi.org/10.1007/s12664-017-0753-5

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