Bariatric surgery and transplantation: A bridge not so far
Notice bibliographique
Résumé
To the Editor: We read the recent article “Obesity, Transplantation, and Bariatric Surgery: An Evolving Solution for Growing Epidemic”1Diwan TS Lee TC Nagai S et al.Obesity, transplantation, and bariatric surgery: an evolving solution for a growing epidemic.Am J Transplant. 2020; 00: 1-13Google Scholar with great interest. The authors have provided excellent evidence in favor of bariatric surgery in the transplant population. We agree in principle that bariatric surgery improves posttransplant outcomes based on the available evidence. We would like to emphasize further the role of bariatric surgery in the liver transplant population. In the pretransplant population, there is conflicting evidence whether bariatric surgery improves survival outcomes. Mosko et al2Mosko JD Nguyen GC. Increased perioperative mortality following bariatric surgery among patients with cirrhosis.Clin Gastroenterol Hepatol. 2011; 9: 897-901Abstract Full Text Full Text PDF PubMed Scopus (163) Google Scholar reported increased perioperative mortality following bariatric surgery among patients with cirrhosis (compensated cirrhotic patients n = 3888, decompensated cirrhotic patients n = 62). This experience was further echoed by Asrani et al3Asrani S Khan F Saracino G et al.Bariatric surgery and increased risk of death after listing for liver transplantation.Am J Transplant. 2016; 16Google Scholar in their report on bariatric surgery and increased risk of death after listing for liver transplant. This is in comparison to smaller case series in which noninferior outcomes to access and transplant have been reported.4Lin MYC Mehdi Tavakol M Sarin A et al.Laparoscopic sleeve gastrectomy is safe and efficacious for pretransplant candidates.Surg Obes Relat Dis. 2013; 9: 653-658Abstract Full Text Full Text PDF PubMed Scopus (119) Google Scholar, 5Safwan M Collins KM Abouljoud MS Salgia R. Outcome of liver transplantation in patients with prior bariatric surgery.Liver Transpl. 2017; 23: 1415-1421Crossref PubMed Scopus (35) Google Scholar, 6Takata MC Campos GM Ciovica R et al.Laparoscopic bariatric surgery improves candidacy in morbidly obese patients awaiting transplantation.Surg Obes Relat Dis. 2008; 4 (;discussion 164–155.): 159-164Abstract Full Text Full Text PDF PubMed Scopus (156) Google Scholar Hiembeck et al7Heimbach JK Watt KDS Poterucha JJ et al.Combined liver transplantation and gastric sleeve resection for patients with medically complicated obesity and end-stage liver disease.Am J Transplant. 2013; 13: 363-368Crossref PubMed Scopus (170) Google Scholar have been pioneers in regard to simultaneous sleeve gastrectomy with liver transplant (S-LT), but despite their experience being in the clinical domain since 2013, it is yet to be mirrored by other institutions. We firmly opine that the donor and recipient characteristics would have to be the benchmark for S-LT, and thus only a selected group of patients shall qualify for the procedure. It is interesting that most S-LT reports have emphasized recipient characteristics and have not given due credit to the quality of allografts; future studies need to highlight the allograft details in the outcome data. Delayed sleeve gastrectomy with liver transplant (D-LT) experience is still maturing, and despite a few reports of post perioperative and postoperative complications,8Elli EF Gonzalez-Heredia R Sanchez-Johnsen L Patel N Garcia-Roca R Oberholzer J. Sleeve gastrectomy surgery in obese patients post-organ transplantation.Surg Obes Relat Dis. 2016; 12: 528-534Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar,9Al-Nowaylati A-R Al-Haddad BJS Dorman RB et al.Gastric bypass after liver transplantation.Liver Transpl. 2013; 19: 1324-1329Crossref PubMed Scopus (67) Google Scholar the evidence is still in favor. We believe that there is a paucity of bariatric surgeons who would be willing to operate on the pretransplant cirrhotic patient population. The struggle in the future would be to provide training to transplant surgeons in bariatric surgery or vice versa, and there is no cross-training provision in ASTS training curriculum. The present era of liver transplant is already limping to find good-quality donors; the quest to find good donors for suitable S-LT recipients may be an uphill task. It may also be difficult to set guidelines for bariatric surgery in liver transplant patients due to limited clinical evidence.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,006 | 0,032 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,003 | 0,002 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,002 | 0,004 |
| Communication savante | 0,005 | 0,010 |
| Science ouverte | 0,003 | 0,002 |
| Intégrité de la recherche | 0,014 | 0,031 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,008 | 0,005 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».