Metabolic Surgery Reduces Liver Disease Risk in Patients with MASH-Related Cirrhosis: Study

A recent study found metabolic surgery to demonstrate significant benefits in lowering the risk of major adverse liver outcomes (MALO) for cirrhosis patients due to metabolic dysfunction-associated steatohepatitis (MASH). The findings published in the recent issue of Nature Medicine journal suggest that surgical intervention could provide a safer and more effective treatment option when compared to traditional nonsurgical management.

Cirrhosis is marked by scarring and impaired function of liver which often progresses without clear therapeutic solutions. The patients with obesity and histologically confirmed MASH-related cirrhosis face elevated risks of liver failure and related complications. Despite advancements in research, no medical therapy has proven effective at reducing these risks so far.

The Surgical Procedures Eliminate Compensated Cirrhosis In Advancing Long-term (SPECCIAL) study tracked 62 patients who underwent metabolic surgery and compared their outcomes to 106 nonsurgical controls over an average follow-up period of 10 years. The surgery group was predominantly female (68%), as was the control group (71%). The study employed robust estimation methods to balance key baseline characteristics between the two groups by ensuring reliable results.

The cumulative incidence of MALO was 20.9% in the surgical group versus 46.4% in the nonsurgical group. This translates to a 72% lower risk of MALO among patients who underwent metabolic surgery (adjusted hazard ratio 0.28, P=0.003).

The incidence of decompensated cirrhosis where the liver can no longer maintain normal function, was 15.6% in the surgical group when compared to 30.7% in the nonsurgical group. This reflected an 80% lower risk (adjusted hazard ratio 0.20, P=0.01). The findings illuminate the potential role of metabolic surgery in altering the long-term trajectory of cirrhosis in patients with obesity and compensated MASH.

These data suggest that metabolic surgery is not just a weight-loss tool but also a potent therapeutic option for improving liver health. In addition, this has major implications for the future care of patients with cirrhosis linked to metabolic dysfunction. Overall, this study highlights the transformative potential of metabolic surgery as a safe and impactful option.

Source:

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., Wakim-Fleming, J., 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. https://doi.org/10.1038/s41591-024-03480-y