CASE REPORT Intragastric Balloon Followed by Biliopancreatic Diversion in a Liver Transplant Recipient: A Case Report Paolo Gentileschi & Marco Venza & Domenico Benavoli & Francesca Lirosi & Ida Camperchioli & Marco D’Eletto & Alessandra Lazzaro & Vito M. Stolfi & Alessandro Anselmo & Nicola Di Lorenzo & Giuseppe Tisone & Achille L. Gaspari Received: 25 March 2009 / Accepted: 20 May 2009 / Published online: 9 June 2009 # Springer Science + Business Media, LLC 2009 Abstract Liver transplantation is a life-saving procedure for end-stage liver disease. In liver transplant recipients, morbid obesity influences post-operative survival and graft function. In 1996, our patient underwent a successful liver transplantation because of a HCV-related liver failure (body mass index (BMI) 31). Follow-up showed a functional graft and the development of severe obesity up to a BMI of 61 in January 2006. In January 2007, he was submitted to intragastric balloon therapy for 6 months, reaching a BMI of 54. In September 2007, he underwent a biliopancreatic diversion. During follow-up to March 2008, he reached a BMI of 42 with ameliorations of comorbidities. In May 2008, during a hospital admission, he suddenly died of a heart attack. Post mortem study revealed a myocardial infarction. This is the first world case report for this approach. According to our opinion, patient’ s death was not related to bariatric surgery. Keywords Liver transplantation . Morbid obesity . Biliopancreatic diversion Introduction Obesity is one of the most important health problem in Western societies, also called as “a new global epidemic” by the WHO. Morbid obesity is defined as a body mass index (BMI) ≥40 or ≥35 with associated comorbidities. Various treatments have been in use: Conservative medical therapies in these individ- uals generally fail, while surgical operation shows satisfactory results [1]. Morbid obesity surgery has the potential to determine resolution of obesity related diseases [2]. It is also considered as the most effective treatment to achieve long-term weight loss and better quality of life. The feasibility of bariatric surgery in liver transplant recipients is still a matter of debate. Liver transplantation has shown important progress in treatment of patients with end-stage liver disease. Quality of life in these patients has been lately improved with a majority of them being alive at 10 years after liver transplantation. Associated comorbid- ities as obesity influence the quality and quantity of life of transplanted patients increasing morbidity and mortality. Morbid obesity is commonly associated with Nonalco- holic Fatty Liver Disease (NAFLD), which is believed to be the most common type of chronic liver disease and could lead to nonalcoholic steatohepatitis and cirrhosis. In obese patients, liver biopsies show some kind of liver disease in 93% as portal inflammation or hepatitis, and NAFLD progresses in 20–40% to cirrhosis [3]. In liver-transplanted patients, these are risk factors that are considered as certain accelerators of basic pathology increasing morbidity and mortality. OBES SURG (2009) 19:1460–1463 DOI 10.1007/s11695-009-9877-8 P. Gentileschi (*) : M. Venza : D. Benavoli : F. Lirosi : I. Camperchioli : M. D’Eletto : A. Lazzaro : V. M. Stolfi : N. Di Lorenzo : A. L. Gaspari Department of Surgery, University of Tor Vergata, Viale Oxford 81, 00133 Rome, Italy e-mail: gentilp@yahoo.com A. Anselmo : G. Tisone Liver Transplant Unit, University of Tor Vergata, P.le dell’Umanesimo 10, 00144 Rome, Italy