Metabolic Surgery Offers Significant Long-Term Benefits for Patients with MASH-Related Cirrhosis: Study Finds

"Over 15 years, the cumulative incidence of MALO was 20.9% in the surgery group compared to 46.4% in the nonsurgical group (adjusted hazard ratio [aHR] 0.28). Additionally, decompensated cirrhosis was notably reduced in those who underwent surgery, with rates of 15.6% versus 30.7% in the nonsurgical group (HR 0.20)," the researchers reported in Nature Medicine.

Metabolic dysfunction-associated steatohepatitis, a form of cirrhosis closely linked to obesity and metabolic syndrome, currently lacks approved medical therapies, leaving patients with limited treatment options. Considering this, Steven E. Nissen, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA, and colleagues conducted The SPECCIAL (Surgical Procedures Eliminate Compensated Cirrhosis In Advancing Long-term) observational study to evaluate the outcomes of metabolic surgery compared to nonsurgical management in patients with obesity and histologically confirmed compensated MASH-related cirrhosis.

The researchers employed a doubly robust estimation methodology to balance key baseline characteristics between groups. They analyzed the time to incident MALO in 62 patients (68% female) who underwent metabolic surgery compared to 106 nonsurgical controls (71% female), with a mean follow-up period of 10.0 ± 4.5 years.

Key Findings:

• The 15-year cumulative incidence of major adverse liver outcomes was 20.9% in the surgical group compared to 46.4% in the nonsurgical group, with an adjusted hazard ratio of 0.28.
• The 15-year cumulative incidence of decompensated cirrhosis was 15.6% in the surgical group compared to 30.7% in the nonsurgical group, with an adjusted hazard ratio of 0.20.

The authors concluded that in patients with compensated MASH-related cirrhosis and obesity, metabolic surgery was associated with a significantly reduced risk of developing major adverse liver outcomes compared to nonsurgical management. They emphasized that, in the absence of approved medical therapies for this condition, metabolic surgery could serve as a safe and effective therapeutic approach to alter the progression of cirrhosis.

Reference:

Aminian, A., Aljabri, A., Wang, S., Bena, J., Allende, D. S., Rosen, H., Arnold, E., Wilson, R., Milinovich, A., Loomba, R., Sanyal, A. J., Alkhouri, N., Laique, S. N., Dasarathy, S., McCullough, A. J., & Nissen, S. E. (2025). Long-term liver outcomes after metabolic surgery in compensated cirrhosis due to metabolic dysfunction-associated steatohepatitis. Nature Medicine, 1-8. https://doi.org/10.1038/s41591-024-03480-y