[Metabolic bariatric surgery as bridging to transplantation-Concepts and results].

BACKGROUND

Due to the generally increasing number of obese patients with obesity-associated comorbidities (e.g. type 2 diabetes mellitus and nonalcoholic fatty liver disease/steatohepatitis), they are increasingly becoming transplantation candidates; however, this patient cohort is more frequently affected by intraoperative and postoperative complications and poorer transplant outcome.

OBJECTIVE

This article provides an overview of the indications, choice of procedure and outcome of bariatric surgery prior to solid organ transplantation.

MATERIAL AND

METHODS

The current literature was evaluated and discussed.

RESULTS

Postoperative complications occur more frequently in bariatric patients with (terminal) organ dysfunction than without but the mortality remains low. On the other hand, these patients can be successfully transplanted significantly more often due to weight loss, with a better transplant outcome. In a not insignificant proportion of patients, the operation even leads to an improvement in the underlying disease, so that there is no longer an indication for listing. In the case of liver cirrhosis, bariatric surgery should only be performed in the compensated stage (Child-Pugh A and early B, no higher stage of portal hypertension). Sleeve gastrectomy and Roux-en‑Y gastric bypass are to be preferred. Multidisciplinary care at a center is particularly important in this patient group.

DISCUSSION: Bariatric surgery as a bridging procedure to transplantation appears to be safe but data and evidence are limited due to low overall patient numbers and pending prospective randomized trials.