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Bariatric transplant

Laura Tariciotti, Stefano D'Ugo, Tommaso Maria Manzia, Valeria Tognoni, Giuseppe Sica, Paolo Gentileschi, Giuseppe Tisone
INTRODUCTION: Obesity is a contributor to the global burden of chronic diseases, including non-alcoholic fatty liver disease and non-alcoholic steatohepatitis (NASH). NASH cirrhosis is becoming a leading indication for liver transplant (LT). Obese transplanted patients have higher morbidity and mortality rates. One strategy, to improve the outcomes in these patients, includes bariatric surgery at the time of LT. Herein we report the first European combined LT and sleeve gastrectomy (SG)...
September 21, 2016: International Journal of Surgery Case Reports
Brian Camilleri, Julie M Bridson, Ajay Sharma, Ahmed Halawa
Obesity is associated with worse short-term outcomes after kidney transplantation but the effect on long-term outcomes is unknown. Although some studies have reported worse outcomes for obese recipients when compared to recipients with a BMI in the normal range, obese recipients who receive a transplant have better outcomes than those who remain wait-listed. Whether transplant candidates should be advised to lose weight before or after transplant has been debated and this is mainly due to the gap in the literature linking pre-transplant weight loss with better outcomes post-transplantation...
October 2016: Transplantation Reviews
Burcin Ekser, Richard S Mangus, Chandrashekhar A Kubal, Jonathan A Fridell, John A Powelson, Santosh Nagaraju, Plamen Mihaylov, Carrie L Phillips, Romil Saxena, William C Goggins
BACKGROUND: Enteric hyperoxaluria (EH) occurs with a rate of 5-24% in patients with inflammatory bowel disease, ileal resection and modern bariatric surgery. The excessive absorption of calcium oxalate causes chronic kidney disease (CKD) in patients with EH. In the literature, a single experience was reported in combined intestine-kidney transplantation (CIKTx) in patients with CKD due to EH. METHODS: After a report of 2 successful cases of CIKTx in patients with EH and CKD, one was performed at our center in a 59-year-old Caucasian female who developed intestinal failure with total parenteral nutrition (TPN) dependence after a complication post-bariatric surgery...
2016: American Journal of Nephrology
Denise J Lo, Blayne A Sayed, Nicole A Turgeon
PURPOSE OF REVIEW: Advances in surgical technique and immunosuppression have significantly improved outcomes after pancreas transplantation, and as a result pancreas transplants increasingly are being performed for indications other than type 1 diabetes mellitus. This review summarizes the current literature on pancreas transplantation in unconventional recipient populations. RECENT FINDINGS: An increasing body of work suggests that pancreas transplantation can be performed with good outcomes in patients with type 2 diabetes mellitus and those 50 years of age and older...
August 2016: Current Opinion in Organ Transplantation
Ilanit Mahler, Tuvia Ben Gal, Hanoch Kashtan, Andrei Keidar
Morbid obesity affects the function of the transplanted heart either directly, by damaging many elements that affect cardiac function or indirectly, by the initial appearance or worsening of co-morbidities that affect the heart. Bariatric surgery is the most effective treatment for a significant and sustained decrease in weight and it leads to the disappearance of co-morbidities such as diabetes, hypertension and dyslipidemia in high rates. These diseases can damage the blood vessels of the graft and impair its function...
March 2016: Harefuah
J-H Chen, C-H Lee, C-M Chang, W-Y Yin
In kidney transplantation, obesity is associated with poorer graft survival and patient survival. Bariatric surgery may provide benefit for these patients, not only by inducing weight loss, but also via reduction of diabetes. We report a case of morbid obesity, poorly controlled new-onset diabetes mellitus, and gout after kidney transplantation that was treated with laparoscopic sleeve gastrectomy 3 years after kidney transplantation. After 1 year of follow-up, 76% excessive body weight loss was attained. No complications were noted...
April 2016: Transplantation Proceedings
Michel Gagner, Colleen Hutchinson, Raul Rosenthal
BACKGROUND: For the purpose of building best practice guidelines, an international expert panel was surveyed in 2014 and compared with the 2011 Sleeve Gastrectomy Consensus and with survey data culled from a general surgeon audience. OBJECTIVES: To measure advancement on aspects of laparoscopic sleeve gastrectomy and identify current best practices. SETTING: International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) 2014, Fifth International Summit for Laparoscopic Sleeve Gastrectomy, Montréal, Canada...
May 2016: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
Neil Lunt, Daniel Horsfall, Johanna Hanefeld
The scoping review focuses on medical tourism, whereby consumers elect to travel across borders or to overseas destinations to receive their treatment. Such treatments include: cosmetic and dental surgery; cardio, orthopaedic and bariatric surgery; IVF; and organ and tissue transplantation. The review assesses the emerging focus of research evidence post-2010. The narrative review traverses discussion on medical tourism definitions and flows, consumer choice, clinical quality and outcomes, and health systems implications...
June 2016: Maturitas
Narendra Singh Choudhary, Rajesh Puri, Neeraj Saraf, Sanjiv Saigal, Naveen Kumar, Rahul Rai, Amit Rastogi, Sanjay Goja, Prashant Bhangui, Sumana K Ramchandra, Vikram Raut, Randhir Sud, Arvinder Soin
INTRODUCTION: In extreme obesity, bariatric surgery or weight loss by lifestyle modification is often not possible because of presence of decompensated cirrhosis. Endoscopic intragastric balloon placement may be used as minimal invasive technique to promote weight loss and make them better candidates for liver transplantation surgery; however, there is no literature in this regard. METHODS: Patients with body mass index (BMI) >40 kg/m(2) or BMI between 35 and 40 (with a low graft to recipient weight ratio) were considered for weight reduction modalities including dietary counseling and intragastric balloon placement when feasible...
March 2016: Indian Journal of Gastroenterology: Official Journal of the Indian Society of Gastroenterology
Amanda R Vest, Parag Patel, Philip R Schauer, Mary Ellen Satava, João L Cavalcante, Stacy Brethauer, James B Young
BACKGROUND: Obesity is a risk factor for development of left ventricular systolic dysfunction (LVSD) and can complicate LVSD management, especially for individuals in whom cardiac transplantation is indicated. Bariatric surgery is increasingly recognized as a safe and effective intervention to achieve marked weight loss, but experience is limited in the LVSD population. METHODS AND RESULTS: We retrospectively reviewed patients with obesity and left ventricular ejection fraction (LVEF) <50% who underwent bariatric surgery at a tertiary center 2004 to 2013...
March 2016: Circulation. Heart Failure
Nancy Hadjievangelou, Myutan Kulendran, Emma Rose McGlone, Marcus Reddy, Omar A Khan
Obesity is common amongst patients with renal transplants (RT). It is associated not only with generic obesity-related complications including diabetes, but also with higher rates of graft rejection and loss. A Best Evidence Topic in surgery was written according to a structured protocol: this is a systematic review of the literature, suitable when the quality of available evidence is low. The question addressed was: is weight-loss surgery (WLS) safe and effective in patients that have had a previous renal transplant? Three prospective case series and one multicentre retrospective study were identified, together reporting on a total of 112 patients who underwent WLS after RT...
April 2016: International Journal of Surgery
Enrique F Elli, Raquel Gonzalez-Heredia, Lisa Sanchez-Johnsen, Neil Patel, Raquel Garcia-Roca, Jose Oberholzer
BACKGROUND: Among organ transplant recipients, a common side effect of immunosuppressive therapy is the development of obesity, which affects a third of the patients within 3 years after transplantation. Bariatric surgery represents a possible surgical option for weight loss among posttransplant patients. OBJECTIVES: The aim of this study was to examine percent excess weight loss (%EWL), and percent weight loss (%WL) and perioperative and postoperative complications in posttransplant obese patients after sleeve gastrectomy (SG) compared with nontransplant patients...
March 2016: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
Yuval A Patel, Carl L Berg, Cynthia A Moylan
Nonalcoholic fatty liver disease (NAFLD) is the most common etiology of chronic liver disease in developed countries and is on trajectory to become the leading indication for liver transplantation in the USA and much of the world. Patients with NAFLD cirrhosis awaiting liver transplant face unique challenges and increased risk for waiting list stagnation and dropout due to burdensome comorbidities including obesity, diabetes, cardiovascular disease, and kidney disease. Thus far, patients transplanted for NAFLD cirrhosis have excellent mid- and long-term patient and graft survival, but concerns regarding short-term morbidity and mortality continue to exist...
May 2016: Digestive Diseases and Sciences
J Moran, F Wilson, E Guinan, P McCormick, J Hussey, J Moriarty
BACKGROUND: Cardiopulmonary exercise testing (CPET) is used as a preoperative risk-stratification tool for patients undergoing non-cardiopulmonary intra-abdominal surgery. Previous studies indicate that CPET may be beneficial, but research is needed to quantify CPET values protective against poor postoperative outcome [mortality, morbidity, and length of stay (LOS)]. METHODS: This systematic review aimed to assess the ability of CPET to predict postoperative outcome...
February 2016: British Journal of Anaesthesia
M Masrur, E Elli, L F Gonzalez-Ciccarelli, P C Giulianotti
INTRODUCTION: It has been reported in the literature that upper gastrointestinal malignancies after bariatric surgery are mostly gastro-esophageal, although it is not clear whether bariatric surgery represents a risk factor for the development of esophageal and/or gastric cancer. We report a case of a de novo gastric adenocarcinoma occurring in a transplant patient 1 year after a laparoscopic sleeve gastrectomy. PRESENTATION OF CASE: A 44 year-old woman with a BMI of 38kg/m(2), hypertension, type 1 diabetes mellitus, multiple malignancies and a pancreas transplant underwent laparoscopic sleeve gastrectomy...
2016: International Journal of Surgery Case Reports
Tamás Halmos, Ilona Suba
The intestinal microbiota is well-known for a long time, but due to newly recognized functions, clinician's attention has turned to it again in the last decade. About 100 000 billion bacteria are present in the human intestines. The composition of bacteriota living in diverse parts of the intestinal tract is variable according to age, body weight, geological site, and diet as well. Normal bacteriota defend the organism against the penetration of harmful microorganisms, and has many other functions in the gut wall integrity, innate immunity, insulin sensitivity, metabolism, and it is in cross-talk with the brain functions as well...
January 3, 2016: Orvosi Hetilap
Nancy E Aguilar-Olivos, Paloma Almeda-Valdes, Carlos A Aguilar-Salinas, Misael Uribe, Nahum Méndez-Sánchez
Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide. NAFLD is strongly associated with obesity and metabolic syndrome (MetS). Current treatment of NAFLD is based on weight reduction. Bariatric surgery is the most effective treatment for morbid obesity and its associated metabolic comorbidities. There is evidence indicating that bariatric surgery improves histological and biochemical parameters of NAFLD, but currently is not considered a treatment option for NAFLD...
August 2016: Metabolism: Clinical and Experimental
Subhashini Ayloo, John Armstrong, Scott Hurton, Michele Molinari
The percentage of overweight and obese patients (OPs) waiting for a liver transplant continues to increase. Despite the significant advances occurred in bariatric medicine, obesity is still considered a relative contraindication to liver transplantation (LT). The main aim of this review is to appraise the literature on the outcomes of OPs undergoing LT, treatments that might reduce their weight before, during or after surgery, and discuss some of the controversies and limitations of the current knowledge with the intent of highlighting areas where future research is needed...
September 24, 2015: World Journal of Transplantation
Hernando Rafael
Neurosurgical evidences show that the aging process is initiated between 25 to 30 years of age, in the arcuate nucleus of the hypothalamus. Likewise, experimental and neurosurgical findings indicate that the progressive ischemia in the arcuate nucleus and adjacent nuclei are responsibles at the onset of obesity and, type 2 diabetes mellitus in adults, and essential arterial hypertension (EAH). On the contrary, an omental transplantation on the optic chiasma, carotid bifurcation and anterior perforated space can provoke rejuvenation, gradual loss of body weight, decrease or normalization of hyperglycemia and normalization of EAH; all of them, due to revascularization of the hypothalamic nuclei...
2015: American Journal of Neurodegenerative Disease
Kareem M Abu-Elmagd, Guilherme Costa, David McMichael, Ajai Khanna, Ruy J Cruz, Neha Parekh, Masato Fujiki, Koji Hashimoto, Cristiano Quintini, A Darlene Koritsky, Matthew D Kroh, Hiroshi Sogawa, Ahmed Kandeel, Jose Renan da Cunha-Melo, Ezra Steiger, Donald Kirby, Laura Matarese, Abdullah Shatnawei, Abhinav Humar, R Matthew Walsh, Philip R Schauer, Richard Simmons, Timothy Billiar, John Fung
OBJECTIVE: Bariatric surgery (BS) is currently the most effective treatment for severe obesity. However, these weight loss procedures may result in the development of gut failure (GF) with the need for total parenteral nutrition (TPN). This retrospective study is the first to address the anatomic and functional spectrum of BS-associated GF with innovative surgical modalities to restore gut function. METHODS: Over 2 decades, 1500 adults with GF were referred with history of BS in 142 (9%)...
October 2015: Annals of Surgery
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