Transplant Medicine

Overview

The incidence of liver failure associated with obesity is on the rise in the United States. At Mayo Clinic's campus in Rochester, Minnesota, Julie K. Heimbach, M.D., transplant surgeon, and Todd A. Kellogg, M.D., bariatric surgeon, discuss a pioneering technique that combines liver transplant and gastric sleeve resection into a single surgery.

The combined procedure serves a patient population with nonalcoholic fatty liver disease or nonalcoholic steatohepatitis — an audience that traditionally has been left with few treatment options.

At many other hospitals, these patients are turned away for transplant and asked to return when they lose weight. In other cases, patients will receive liver transplant but face the risk of short- and long-term complications due to their excess weight.

If the liver transplant and gastric sleeve resection take place as two separate surgeries, the gastric sleeve surgery may be technically more demanding due to scar tissue from the liver transplant and immunosuppressant medications. This reason is the impetus behind Mayo Clinic's innovative approach combining both operations.

Video content outline:

• Introduction
• Mayo Clinic's surgical innovation for people with obesity and liver failure (0:31)
• Results (1:02)
• Challenges and risks to alternative approaches (1:18)
• Benefits to combined approach (3:42)
  • Exposure for liver transplant and upper abdomen during surgery (3:43)
  • Benefit of gastric sleeve vs. gastric bypass following liver transplant (4:00)
• Conclusion (4:42)