Patient description: The patient is a 25-year-old man with type 1 diabetes confirmed with molecular analysis 7 years ago. He presents to the clinic with shortness of breath and fatigue during activities. He claims mild dyspnea after climbing 3 floors, no dyspnea at rest and no angina (New York Heart Association class 2). He is diagnosed with cardiomyopathy that will be treated with ACE inhibitors and Beta blockers. His takes 70/30 Insulin and vitamin D supplements. His past medical history is not significant for any other medical issues. His family history is positive for DM type 1 in his uncle and his grandfather. His lab study is as bellow: FBS: 100 mg/dl HbA1c: 6.5% Cholesterol: 190 mg/dl TG: 140 mg/dl LDL: 125 mg/dl HDL: 40 mg/dl

Clinical trial eligibility criteria: eligible ages (years): 18.0-75.0,  Obesity Cardiovascular Disease Type 2 Diabetes Hypertension Complication of Transplant Subjects must be willing to give written informed consent Adult subjects 18-75 years of age of any race or gender who are listed for liver transplantation For consideration of sleeve gastrectomy placement patients must meet the following 1. Class III Obesity (BMI ≥ 40 kg/m2); or 2. Class II Obesity (BMI 35-39.9 kg/m2 in conjunction with any of the following severe obesity related co-morbidities): i. Obstructive sleep apnea defined as a formal sleep study consistent with this diagnosis with a) an Epworth sleepiness scale ≥ 6 and b) polysomnography with respiratory disturbance index ≥ 10 and/or apneic episodes per hour of sleep; or ii. Cardiovascular disease defined as prior history of stroke, myocardial infarction, stable or unstable angina pectoris, or prior coronary artery bypass); or iii. Medically refractory hypertension defined as blood pressure greater than 140 mmHg systolic and/or 90 mmHg diastolic despite concurrent use of 3 anti-hypertensive agents of different classes iv. Type 2 diabetes mellitus, defined as individuals taking insulin or oral hypoglycemic agents or who have a fasting glucose > 126 mg/dL 2. Have attempted (and failed) previous weight loss efforts over at least a three month period with diet, exercise, lifestyle changes or medications. 3. Show understanding of the risks and benefits of surgery and side effects of the procedure. 4. Be committed to lifestyle changes. All patients will be evaluated by the transplant psychologist as well as the bariatric surgery psychologist prior to consideration for study enrollment to ensure appropriate psychological motivation. 5. Do not have any medical, psychiatric or emotional condition that would prohibit surgery (e.g. severe irreversible coronary artery disease, untreated schizophrenia, active substance abuse, and/or noncompliance with previous medical care)  Status 1 listing (fulminant hepatic failure) for liver transplant Active drug abuse or alcohol use within six months Positive urine pregnancy test (females) Diagnosis of active malignancy History of prior bariatric surgery Failure to attend the initial patient information sessions or history of noncompliance Failure to give consent for the study or to understand the proposed consent Failure of patient's insurance company to approve surgical intervention so as to avoid extensive cost burden on the patient