San Francisco – Preliminary data from a new study presented this week at The Liver Meeting® – held by the American Association for the Study of Liver Diseases – found that weight-loss surgery prior to liver transplantation is superior to medical weight loss approaches at achieving sustained weight loss, as well as significantly lowering risk of metabolic complications after transplant.
Obesity-related liver disease is expected to become the leading indication for liver transplantation in the United States over the next 10 years. Strategies to optimize weight loss and the management of obesity-related metabolic complications after transplant are needed. Researchers at the University of California, San Francisco, compared pre-liver transplantation weight-loss surgery and medical weight loss to examine outcomes after liver transplantation.
“The prevalence of obesity among liver transplant candidates is significantly increasing. Further research is needed to determine the optimal management of this population, as obesity confers a higher risk of post-liver transplantation complications related to metabolic syndrome,” explains Suzanne Sharpton, MD, MAS, who is a transplant hepatology fellow at UCSF and the study’s co-author. “While weight-loss surgery is more effective than medical weight loss in improvement in obesity-related comorbidities in the general population, little is known about the efficacy of weight-loss surgery in patients undergoing liver transplantation and how this affects their outcomes.”
In the retrospective cohort study, the researchers looked at adults 18 and older with a BMI of 35 or higher who were waitlisted for liver transplantation at UCSF between January 1, 2006 and January 1, 2016, and who were deemed eligible for pre-liver transplantation weight-loss surgery to manage their obesity-related complications. They evaluated the association of pre-liver transplantation weight-loss surgery on progressive diabetes and high blood pressure, defined as new-onset disease or escalation of pharmacologic treatment for existing disease fewer than 60 days after liver transplantation. They also evaluated the association of pre-liver transplantation weight-loss surgery on recurrent or de novo nonalcoholic fatty liver disease, or NAFLD, after transplantation, as defined by liver biopsy or elevated liver enzymes and new hepatic steatosis on imaging.
Among 70 liver transplantation candidates, 14 underwent pre-liver transplantation weight-loss surgery, and 56 elected for medical weight loss. The researchers followed the patients for a median of 4.7 years after liver transplantation. The patients who opted for weight-loss surgery had a higher median BMI, but lower Model for End-Stage Liver Disease, or MELD, score at the time they were added to the waitlist for transplantation. These patients also achieved a higher percentage of total body weight loss by the time of their transplantation, and they were more likely to sustain this weight loss at one year and three years after. The BMI at three years after liver transplantation was significantly lower in the weight-loss surgery group compared to the medical weight loss group.
The patients who opted for weight-loss surgery before liver transplantation also had significantly lower risk of progressive diabetes, high blood pressure and recurring NAFLD compared to patients who chose medical weight loss prior to liver transplantation, the study found. Weight-loss surgery was not only more successful at achieving sustained weight loss after liver transplantation, but also resulted in significantly lower risk of metabolic complications for these patients.
“Our results demonstrate that weight-loss surgery in carefully selected patients, as compared to non-surgical weight loss, leads to marked improvement in obesity-related morbidities after transplant,” says Dr. Sharpton. “Our next steps are to better delineate both the most appropriate timing of the pre-liver transplantation weight-loss surgery procedure and refining patient selection criteria in order to identify those patients that would derive the greatest benefit with the least risk of harm. Moreover, we plan to examine whether pre-liver transplantation weight-loss surgery leads to less risk of dropout on the waitlist when compared to medical weight loss strategies.”
Dr. Sharpton will present the study entitled “Weight Loss Surgery Pre-Liver Transplantation is Superior to Medical Weight Loss in Reducing Post-Transplant Metabolic Complications” on Sunday, November 11 at 2:00 PM in Room 153/155. The corresponding abstract (number 0123) can be found in the journal, HEPATOLOGY.