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Liver transplantation for decompensated cirrhosis after jejunoileal bypass: a strategy for management
J S Markowitz1, P Seu, J A Goss
1Department of Surgery, UCLA Medical Center, Los Angeles, California 90095, USA.
Insights
Jejunoileal bypass can lead to liver disease. Reversing the bypass during liver transplantation improves outcomes and prevents recurrent liver issues, benefiting patients with end-stage liver disease.
Area of Science:
- Hepatology
- Transplant Surgery
- Gastroenterology
Background:
- Jejunoileal bypass (JIB) is a known cause of end-stage liver disease (ESLD).
- Outcomes following liver transplantation in patients with JIB-associated liver disease are not well-established.
Purpose of the Study:
- To review the outcomes of liver transplantation in patients with decompensated cirrhosis secondary to jejunoileal bypass.
- To assess the impact of jejunoileal bypass reversal on post-transplant liver function and patient status.
Main Methods:
- Retrospective review of six patients undergoing liver transplantation for JIB-associated cirrhosis.
- Assessment of liver function, allograft pathology, renal function, and nutritional status.
- Comparison between patients with intact JIB and those with reversed JIB at transplantation.
Main Results:
- Recurrent steatotic liver disease was observed in two of three patients with an intact jejunoileal bypass.
- Patients with reversed jejunoileal bypass showed improved biochemical markers (lower alkaline phosphatase, lower creatinine, higher albumin) and higher cholesterol and obesity levels compared to those with intact bypass.
Conclusions:
- Reversal of jejunoileal bypass during liver transplantation is recommended for patients with JIB-associated liver disease.
- Close monitoring and routine biopsies are essential for patients with intact bypasses, with reversal indicated if recurrent liver disease develops.
Background:
Although jejunoileal bypass results in end-stage liver disease in up to 100% of patients, little is known about outcome after liver transplantation.
Methods:
The clinical courses of six patients who underwent liver transplantation at UCLA for decompensated cirrhosis owing to a jejunoileal bypass were reviewed. Liver function, allograft pathology, renal function, and nutritional status were assessed.
Results:
Of the four patients with an intact jejunoileal bypass, two of the three who were biopsied had recurrent steatotic liver disease. The two patients whose jejunoileal bypass was reversed at the time of liver transplantation had lower alkaline phosphatase, lower creatinine, higher albumin, and higher cholesterol, and were more obese than their counterparts with intact bypasses.
Conclusions:
Patients undergoing liver transplantation for jejunoileal bypass-associated liver disease should, if possible, have their bypass reversed at the time of transplantation; otherwise, they must be followed closely and be biopsied routinely. Recurrent liver disease should prompt reversal of the jejunoileal bypass.
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