A Case Report of a Simultaneous Pediatric Orthotopic Liver Transplant and Vertical Sleeve Gastrectomy in a 10-Year-Old Male With Cirrhosis and Obesity.

Creator(s)

Lakshmi Kunam, Children's Mercy Kansas CityFollow
Brooke Sweeney, Children's Mercy Kansas CityFollow
Ryan T. Fischer, Children's Mercy HospitalFollow
Neal Campbell, Children's Mercy HospitalFollow
Jason D. Fraser
Richard Hendrickson
Bhargava Mullapudi
Manish K. Kotecha, Children's Mercy HospitalFollow
Meredith Dreyer, Children's Mercy Kansas CityFollow
Voytek Slowik, Children's Mercy HospitalFollow

Document Type

Article

Publication Date

8-2025

Identifier

DOI: 10.1111/petr.70124

Abstract

BACKGROUND: Liver transplantation is a lifesaving procedure for children with end-stage liver disease. Obesity and weight gain can lead to post-transplant steatosis and increased morbidity and mortality. Bariatric surgery improves outcomes in children with severe obesity by reducing weight and subsequent comorbidities. We present a case of simultaneous orthotopic liver transplant and vertical sleeve gastrectomy.

METHODS: Retrospective case report.

RESULTS: An 8-year-old male presented with right upper quadrant pain. Workup demonstrated cirrhosis with portal hypertension due to a vertically transmitted hepatitis C virus (HCV). Despite treatment for HCV, he developed decompensated disease and was listed for liver transplantation at 10 years of age. Due to class 3 severe obesity and associated comorbidities, he underwent a simultaneous vertical sleeve gastrectomy (VSG) and deceased donor orthotopic liver transplantation. Postoperative course was complicated by a prolonged oxygen requirement that resolved within 2 weeks. No staple line or gastric bleeding issues were noted. More than 1 year after transplantation, he has good graft function on tacrolimus monotherapy. He had a 21.1% reduction from his peak BMI of 42.97 to 33.91 kg/m

CONCLUSION: Our experience demonstrates that liver transplant and vertical sleeve gastrectomy can be done concomitantly and safely in selected pediatric patients. Assessing the long-term outcomes of this and other similar patients will assist in the determination of optimal patient selection, target and actual BMI reduction, and metabolic goals in the pediatric liver transplant population.

Journal Title

Pediatric transplantation

Volume

29

Issue

5

First Page

70124

Last Page

70124

MeSH Keywords

Humans; Male; Liver Transplantation; Child; Liver Cirrhosis; Gastrectomy; End Stage Liver Disease; Pediatric Obesity; Retrospective Studies; Hypertension, Portal; Treatment Outcome; Obesity, Morbid

PubMed ID

40556105

Keywords

bariatric surgery; liver; obesity; pediatrics; steatosis

Recommended Citation

Kunam L, Sweeney B, Fischer RT, et al. A Case Report of a Simultaneous Pediatric Orthotopic Liver Transplant and Vertical Sleeve Gastrectomy in a 10-Year-Old Male With Cirrhosis and Obesity. Pediatr Transplant. 2025;29(5):e70124. doi:10.1111/petr.70124