Modern Era Experience with Concurrent Liver Transplantation and Sleeve Gastrectomy: A MBSAQIP-Based Analysis of 30-Day Outcomes

Background Concurrent sleeve gastrectomy and liver transplantation (LT + SG) is an emerging approach for patients with decompensated cirrhosis and severe obesity. Recent technical advancements may have improved outcomes, yet contemporary data remain limited. Objectives To evaluate trends, characteristics, and 30-day outcomes of patients undergoing concurrent LT + SG in the modern surgical era. Setting: Analysis of 902 accredited bariatric surgery centers across the United States and Canada participating in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). Methods Retrospective analysis of the MBSAQIP database (2020–2023) to identify patients undergoing primary sleeve gastrectomy with concurrent liver transplantation. Demographic characteristics, comorbidities, and 30-day outcomes were assessed. Multivariable logistic regression identified predictors of serious complications. Results Of 523,243 SG patients, 22 (0.004%) underwent concurrent LT + SG. These patients were older (49.5 ± 8.8 vs. 42.9 ± 11.9 years, p  = 0.010), had higher BMI (47.5 ± 4.9 vs. 44.8 ± 7.7 kg/m², p  < 0.0001), and were predominantly male (81.8%) compared to the primarily female SG-alone group (81.7%), p  < 0.0001. The LT + SG cohort experienced significantly higher bleeding rates (63.6% vs. 0.7%, p  < 0.0001), reoperation (18.2% vs. 0.64%, p  < 0.0001), and serious complications (36.4% vs. 1.82%, p  < 0.0001). However, mortality rates were comparable (0.0% vs. 0.06%, p  = 0.91). Conclusions Despite higher complication rates compared to SG alone, concurrent LT + SG appears feasible with acceptable 30-day mortality. The significantly elevated bleeding rates warrant specialized hemostatic strategies and careful patient selection. Future research should compare LT + SG to LT-only patients to determine the true additional risk of performing concurrent SG.