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Thématique :
- Foie
Originalité :
Très original
Solidité :
A confirmer
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
 
 
Hepatology
  2018/08  
 
  2018 Aug;68(2):485-495.  
  doi: 10.1002/hep.29848.  
 
  Long-term outcomes of patients undergoing simultaneous liver transplantation and sleeve gastrectomy.  
 
  Zamora-Valdes D, Watt KD, Kellogg TA, Poterucha JJ, Di Cecco SR, Francisco-Ziller NM, Taner T, Rosen CB, Heimbach JK  
  https://www.ncbi.nlm.nih.gov/pubmed/29457842  
 
 

Abstract
 

Obesity is increasingly common before and after liver transplantation (LT), yet optimal management remains unclear. The aim of this study was to analyze the long-term outcomes for obese patients undergoing LT, including a noninvasive weight loss program and combined LT and sleeve gastrectomy (SG). Since 2006, all patients referred for LT with a body mass index (BMI) ≥35 kg/m2 were enrolled. Patients who achieved weight loss (BMI <35) underwent LT alone, and those who did not underwent simultaneous LT + SG. Analysis of long-term outcomes for patients ≥3 years posttransplant was performed. Since 2006, there were 36 in the weight loss intervention (LT cohort) and 13 in the LT + SG cohort with >3 years of follow-up, whereas overall, a total of 29 patients underwent LT + SG. Patients in the LT cohort had less severe obesity at enrollment (40.0 ± 2.7 vs. LT + SG cohort 46.0 ± 4.5; P < 0.001). In the LT cohort, 83.3% (30 of 36) achieved >10% loss in total body weight (TBW) pre-LT. Three years posttransplant, 29.4% of patients in the LT cohort maintained >10% loss in TBW, whereas 100% of the LT + SG patients did (P < 0.001). Patients who underwent LT + SG maintained a significantly higher percentage of total body weight loss after 3 years of follow-up (LT cohort 3.9 ± 13.3% vs. LT + S G cohort 34.8 ± 17.3%; P < 0.001). Patients in the LT + SG also had a lower prevalence of hypertension, insulin resistance, and hepatic steatosis and required fewer antihypertensive medications and lipid agents at last follow-up.

CONCLUSION:

Whereas weight loss before transplantation was achieved by obese patients, weight regain was common in the LT cohort. Combined LT + SG resulted in more effective and more durable weight loss, as well as fewer metabolic complications at last follow-up. (Hepatology 2018).

 
Question posée
 
Analyse du devenir à long terme de 49 patients obèses traités par transplantation hépatique (TH) engagés dans un programme de réduction du poids et de sleeve gastrectomie (SG) pour 13 d’entre eux associée à la TH.
 
Question posée
 
A 3 ans de suivi, 100% des TH + SG ont maintenu une perte de poids >10%, comparés à moins de 30% de ceux n’ayant pas eu de SG. Associés à cette prise de poids moindre les TH + SG ont présenté moins de syndrome métabolique et ont eu besoin de moins de traitement de l’THA ou anti-lipidique.
 
Commentaires

Chez les patients très obèses, il faut certainement s’engager vers les traitements radicaux de l’obésité, avec une évaluation minutieuse et une discussion au cas par cas.

 
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