Study finds long-term health benefits from bariatric surgery and liver transplant

Simultaneous bariatric surgery and liver transplant for patients who are severely obese is safe and improves long-term health outcomes, according to a recent Mayo Clinic study. This combined approach offers a needed solution for these patients who are often denied a lifesaving liver transplant due to their weight.

The 10-year study, published in the Journal of Hepatology, compared patients who received only a liver transplant with those who underwent both a liver transplant and bariatric surgery.

The combined approach resulted in sustained weight loss, reduced risk of type 2 diabetes and lower risk of fatty liver disease recurrence. Importantly, the combined procedure posed no additional risks compared to liver transplant alone.

"We've been amazed by the transformation our patients experience," says Julie Heimbach, M.D., director of Mayo Clinic Transplant Center in Minnesota and the study's senior author. "This dual approach prevents long-term obesity complications like diabetes, heart disease and cancer, while also preventing fatty liver disease recurrence."

How obesity and liver disease are connected

The percentage of liver transplant candidates in the U.S. with obesity continues to climb, with more than 41% of candidates having a body mass index above 30 in 2022. Obesity puts people at risk of developing metabolic dysfunction-associated steatotic liver disease, or MASLD, formerly known as nonalcoholic fatty liver disease. It's a condition where excess fat accumulates in the liver, which can lead to inflammation, scarring and advanced liver disease. Patients with a body mass index of 40 are more likely to be denied a transplant due to their weight.

"Since MASLD is a leading cause of liver failure, it only makes sense to protect the precious, lifegiving new liver from the same damage that led to the patient needing a transplant in the first place. Safely combining the two procedures protects the transplanted liver and can provide profound health benefits to these patients," says Todd Kellogg, M.D., Mayo Clinic bariatric surgeon and the study's co-author.

What about using new prescription medications for weight loss?

New weight loss medications, such as GLP-1s, are being used to help some pre-transplant and post-transplant patients manage their weight. Still, Mayo Clinic experts say bariatric surgery remains an important option for patients with severe obesity due to its safety, proven effectiveness and lasting results. Another recent Mayo study related to kidney transplant patients supports this.

"The patients that we're talking about really have a significant amount of extra weight. The issue with the GLP-1 medications is they are effective in terms of weight loss as well as other benefits which are being identified, but they may not get these patients with severe obesity to their lasting goal of a healthier weight," Dr. Heimbach says.

Bringing together experts from different medical specialties is essential when treating these patients, says Ty Diwan, M.D., Mayo Clinic transplant surgeon and the study's co-author.

"This study shows that caring for these complex patients extends beyond the transplant itself," Dr. Diwan says. "Multidisciplinary care is required to maximize patient outcomes, and that is what we see in this data. By bringing together experts in very different fields, we've improved patient care and overall health outcomes."

Reference:

Ellen L. Larson, Samia D. Ellias, Daniel J. Blezek, Jason Klug, Robert P. Hartman, Nickie Francisco Ziller, Heather Bamlet, Shennen A. Mao, Dana K. Perry, Induja R. Nimma, Dilhana Badurdeen, Liu Yang, Michael D. Leise, Kymberly D. Watt, Tayyab S. Diwan, Timucin Taner, Charles D. Rosen, Enrique F. Elli, James A. Madura, Caroline C. Jadlowiec, Blanca Lizaola-Mayo, Todd A. Kellogg, Julie K. Heimbach, Simultaneous liver transplant and sleeve gastrectomy provides durable weight loss, improves metabolic syndrome and reduces allograft steatosis, Journal of Hepatology, 2025, https://doi.org/10.1016/j.jhep.2025.02.030.