Sleeve Gastrectomy for Morbid-Obesity Sequelae After Transplantation

Inclusion Criteria: * actively listed for liver transplantation at University Health Network * BMI at screening of a) \>40; or b) BMI \>35 and 1 obesity-related complication \[diabetes (defined as hyperglycemia requiring medication(s) for control), hypertension (defined as a persistently elevated systolic pressure greater than 140 mmHg and/or requiring medication(s) for control), hypercholesterolemia (defined as elevated lipids requiring medication for control)\] OR a diagnosis of Non Alcoholic Fatty Liver Disease (defined as the presence of a fatty liver on imaging without a secondary cause such as alcohol abuse) or Non Alcoholic Steatohepatitis * upper endoscopy showing no contraindications to a sleeve gastrectomy procedure Exclusion Criteria: * • Listed for re-transplantation, or transplantation of another organ (eg. kidney). * Previous bariatric surgery. * Contraindication to undergoing sleeve gastrectomy such as severe gastroesophageal reflux disease or Barrett's Esophagus * MELD (Model End-Stage Liver Disease) score \> 35 at the time of transplantation * Presence of any condition that in the opinion of the investigator(s) could compromise the patient's ability to comply with study procedures * Patients with a BMI \<32 at transplant or having weight loss of 20% or more (pre-transplant estimated dry body weight compared to estimated dry body weight at screening) * Presence of any other condition that, in the opinion of the investigator(s), could compromise the patient's ability to safely undergo, or benefit from, the SG procedure (eg. significant sarcopenia)