ADVANCED LIVER FIBROSIS IS ASSOCIATED WITH DECREASED WEIGHT LOSS AFTER BARIATRIC SURGERY
Thomas J. Wang*1, Kimberly F. Schuster2,3, David B. Lautz2, Laura Doyon2, Pichamol Jirapinyo1, Christopher C. Thompson1, Marvin Ryou1
1Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Boston, MA; 2Emerson Hospital, Concord, MA; 3Tufts Medical Center, Boston, MA
Background
It remains unclear to what extent advanced liver disease affects the efficacy of bariatric surgery in weight loss and improving chronic disease. Therefore, we sought to elucidate the relationship between advanced liver disease and patient outcomes following bariatric surgery.
Methods
This was a retrospective cohort study from a single bariatric center of excellence. We collected data on consecutive patients who underwent primary bariatric surgery (either laparoscopic sleeve gastrectomy (LSG) or Roux-en-Y gastric bypass (RYGB) from Jan 2020 to Sep 2022 with concomitant surgical liver biopsy. Primary outcome was % excess weight loss (EWL) at 3, 6, and 12 months. Secondary outcomes include 30-day adverse events and improvement in hypertension, hyperlipidemia, and type 2 diabetes. Multivariate linear and logistical regression models were used to evaluate associations between patient characteristics and outcomes. Statistical analyses were performed using SAS 9.4.
Results
400 patients were included in this study. Summary of patient demographics are listed in Table 1. 20 (5%) patients had advanced fibrosis or cirrhosis on biopsy (i.e. F3 or F4). There was no significant difference in BMI between patients with F0-2 vs F3-4 on biopsy (mean 44.7 vs 46.3, p=0.19). Patients with advanced fibrosis had significant lower % EBMIL at 3 and 12 months post surgery (32.4 vs 38.0%, p=0.0482 at 3 months, 60.6 vs 76.8%, p=0.0066 at 12 months) [Figure 1A]. On multivariate analysis including advanced fibrosis, age, sex, surgery type (RYGB vs LSG), alcohol use disorder (AUD), active smoking history, hypertension, hyperlipidemia, obstructive sleep apnea, and type 2 diabetes, advanced fibrosis was associated with lower % EBMIL at 12 months only (13.5% lower in EWL, p=0.0486) [Figure 1B]. In addition, AUD was also associated with lower % EBMIL at 12 months, and RYGB was associated with higher % EWL at 6 and 12 months. Presence of advanced fibrosis was not associated with significant differences in improvement in hypertension, hyperlipidemia, or type 2 diabetes within 12 months of surgery. FIB-4 and APRI did not perform better than liver biopsy in predicting % EWL at 12 months (p=0.86 and 0.68 respectively when replacing advanced fibrosis on multivariate analysis).
Conclusions
Presence of advanced fibrosis at time of bariatric surgery was associated with decreased weight loss at 12 months. No association was seen with improvement of other factors of metabolic syndrome, although this analysis may be limited by the small number of patients with advanced fibrosis. Liver fibrosis index scores of FIB-4 and APRI were not helpful in predicting amount of weight loss. Larger multicenter studies may be helpful to better elucidate the relationship between advanced fibrosis and improvement in metabolic syndrome after bariatric surgery.
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