Weight-Loss Surgery May Reduce Liver Disease Complications in Obese Cirrhosis Patients: Study Finds
A Cleveland Clinic study shows that patients with obesity and fatty liver-related cirrhosis who had bariatric (weight-loss) surgery significantly lowered their future risk of developing serious liver complications compared with patients who received medical therapy alone. The results were published in Nature Medicine journal.
Obesity and diabetes are the leading causes of metabolic dysfunction-associated steatohepatitis (MASH). Accumulation of fat within liver cells triggers a cascade of events ultimately leading to liver scarring. About 20% of people with MASH can progress to late-stage liver scarring which is called cirrhosis.
The aim of the SPECCIAL (Surgical Procedures Eliminate Compensated Cirrhosis in Advancing Long-term) study was to examine the long-term outcomes of bariatric surgery on the risk of developing major liver complications in patients with obesity and compensated MASH-related cirrhosis, compared with nonsurgical management.
A group of 62 Cleveland Clinic’s patients with compensated MASH-related cirrhosis and obesity who had bariatric surgery were compared with a control group of 106 nonsurgical patients and followed for 15 years. Study participants had similar characteristics such as severity of liver disease at their baseline liver biopsy.
Fifteen years after enrollment, study results show that 20.9% in the surgical group and 46.4% in the nonsurgical group developed one of the major complications of liver disease including liver cancer and death.
Over the course of 15 years, 15.6% in the surgical group and 30.7% in the nonsurgical group progressed from compensated cirrhosis to the decompensated stage. At 15 years, patients in the bariatric surgery group lost 26.6% (31.6 kg) of their weight and patients in the nonsurgical control group lost 9.8% (10.7 kg) of their weight.
Ali Aminian, M.D., director of Cleveland Clinic’s Bariatric & Metabolic Institute and lead investigator of the study, said results show that bariatric surgery should be considered as a treatment option in patients with cirrhosis and obesity. “Bariatric surgery was associated with a 72% lower risk of developing serious complications of liver disease and an 80% lower risk of progression to decompensated stage among patients with compensated cirrhosis and obesity.”
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