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BARIATRIC SURGERY IS ASSOCIATED WITH REDUCED HAZARD RATIOS OF ADVERSE HEPATIC AND EXTRAHEPATIC OUTCOMES IN PATIENTS WITH METABOLIC DYSFUNCTION-ASSOCIATED STEATOTIC LIVER DISEASE
Weronika Stupalkowska
*2,1, Alexander Henney
1, Daniel Cuthbertson
1, Eric Sheu
21University of Liverpool Faculty of Health and Life Sciences, Liverpool, United Kingdom; 2Laboratory for Surgical and Metabolic Research, Brigham and Women's Hospital, Boston, MA
Background The aim of this study was to determine the impact of MBS on a wide range of individual and composite clinical outcomes in individuals with metabolic dysfunction-associated steatotic liver disease (MASLD) regardless of body mass index (BMI) or the type of bariatric procedure undergone.
Methods Retrospective analysis of anonymised healthcare data recorded between 2004-2024 was conducted using a global health research platform. Patients with MASLD with or without history of MBS (MBS and no-MBS cohorts respectively) were identified using a combination of International Classification of Disease and Current Procedural Terminology codes and validated MASLD screening score (age, BMI, serum alanine aminotransferase). Maximum follow-up was set to 5 years. Patients who had MBS or were diagnosed with MASLD after October 2019 were excluded. Comparative analysis was performed after propensity score matching (PSM). Outcomes of interest included 5-year hazard ratios (HR) of major adverse liver outcomes (MALO), cardiovascular events (MACE), kidney events (MAKE), obesity-associated cancers and all-cause mortality. Data were analysed in October 2024.
Results Network query identified 15,244 patients in the MBS cohort and 969,354 patients in the no-MBS cohort. After PSM for 26 characteristics (demographics, BMI, HbA1c, co-morbidities, biochemistry, medications), the cohorts included 15,112 patients each (mean age: 49.0±12.6 vs 49.1±14.2; % female: 74.3% vs 76.3%). Mean follow-up was 3.97±1.67 and 3.97±1.71 years. At 5 years, MBS was associated with reduced risk in all outcomes of interest (Fig 1): HR
MALO= 0.56 (95%CI: 0.46-0.67), HR
MACE= 0.76 (0.71-0.82), HR
MAKE= 0.56 (0.42-0.74), HR
CANCER= 0.43 (0.38-0.49), and HR
MORTALITY= 0.45 (0.40-0.51). The main drivers of risk reduction in MALO were lower rates of liver transplant (HR 0.08 (0.01-0.59)), new diagnosis of hepatocellular carcinoma (HR 0.22 (0.12-0.40)) and decompensated cirrhosis (HR 0.31 (0.19-0.53)), although the event rate for these outcomes was low irrespective of surgery status (<1%). The main driver of risk reduction in MACE was lower diagnosis rate of heart failure (HR 0.55 (0.48-0.62)) and in MAKE lower rate of progression to dialysis (HR 0.58 (0.42-0.81)). MBS was associated with greatest risk reduction of endometrial and colorectal cancers (HR 0.33 (0.23-0.47) and 0.33 (0.23-0.49) respectively).
Conclusion Within 5 years MBS is associated with significant reductions in major adverse liver, cardiovascular and renal outcomes with lower rates of obesity-associated cancers and all-cause mortality.
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