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Bariatric Surgery Lowers Risk of Liver Complications in Patients with Cirrhosis, Obesity
Metabolic surgery reduced major adverse liver outcomes in people with compensated cirrhosis and obesity by 72%, according to new data.
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Bariatric surgery significantly reduced the risk of severe liver complications in patients with metabolic dysfunction-associated steatohepatitis (MASH)-related cirrhosis and obesity compared with medical therapy alone, according to new research. The findings, published in Nature Medicine, suggest that weight-loss surgery may be an effective treatment option for this high-risk patient population.1
In the observational Surgical Procedures Eliminate Compensated Cirrhosis in Advancing Long-term (SPECCIAL) study, researchers followed 62 patients with compensated MASH-related cirrhosis and obesity who underwent bariatric surgery and compared them with 106 nonsurgical patients over a 15-year period. Participants had similar characteristics, such as severity of liver disease, at baseline.1
At the study’s conclusion, 20.9% of patients in the surgical group developed a major adverse liver outcome (MALO), compared with 46.4% in the nonsurgical group (adjusted HR 0.28, 95% CI 0.12-0.64, P = 0.003).1
Additionally, 15.6% of surgical patients progressed to decompensated cirrhosis, compared with 30.7% in the nonsurgical group (adjusted HR 0.20, 95% CI 0.06-0.68, P = 0.01). At 15 years post-surgery, individuals in the bariatric surgery group achieved an average weight loss of 26.6% (31.6 kg) compared with 9.8% (10.7 kg) in the nonsurgical group.1
MASH, formerly known as nonalcoholic steatohepatitis, is the most common form of chronic liver disease in the US, with approximately 3 million people diagnosed with MASH-related cirrhosis.2
“Currently, lifestyle intervention is the only therapeutic recommendation for compensated MASH-related cirrhosis. However, lifestyle changes alone rarely provide the weight loss and metabolic changes needed to reduce the risk of liver complications in this patient population,” senior investigator Steven Nissen, MD, chief academic officer of the Heart, Vascular and Thoracic Institute of Cleveland Clinic, said in a press release.2 “The SPECCIAL study shows that bariatric surgery is an effective treatment that can influence the trajectory of cirrhosis progression in select patients.”
Previous studies, such as the Cleveland Clinic-led SPLENDOR trial, reported benefits for metabolic surgery in patients with MASH but without cirrhosis. The current study is the first to assess long-term clinical outcomes after metabolic surgery in patients with obesity and MASH-related cirrhosis. Further research is needed to confirm these findings in more diverse populations and to investigate the potential benefits of bariatric surgery in patients with decompensated cirrhosis.2
References:
1. Aminian A, Aljabri A, Wang S, et al. Long-term liver outcomes after metabolic surgery in compensated cirrhosis due to metabolic dysfunction-associated steatohepatitis. Nat Med. Published online January 27, 2025. doi:10.1038/s41591-024-03480-y
2. Weight-loss surgery lowers risk of developing complications of liver disease in patients with cirrhosis and obesity. News release. Cleveland Clinic. January 27, 2025. Accessed January 2, 2025. https://newsroom.clevelandclinic.org/2025/01/27/weight-loss-surgery-lowers-risk-of-developing-complications-of-liver-disease-in-patients-with-cirrhosis-and-obesity
