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Abstract Details
Persistence of severe liver fibrosis despite substantial weight loss with bariatric surgery
Hepatology. 2022 Jan 25. doi: 10.1002/hep.32358. Online ahead of print.
Assistance Publique Hôpitaux De Paris, Hôpital Pitié-Salpêtrière, Paris, France.
Sorbonne Université, Paris, France.
Institute of Cardiometabolism and Nutrition, Paris, France.
Centre de Recherche Saint Antoine, INSERM UMRS_938 Paris, France.
CRNH Ile de France, INSERM, UMRS U1269, Nutrition and Obesities Systemic Approaches (NutriOmics), Paris, France.
INSERM UMRS 1138 CRC Paris, France, Paris.
Abstract
Background & aims: It remains unclear to what extent and which components of advanced liver disease improve after bariatric surgery. We herein describe the histological outcome in patients with advanced NASH and its relationship with weight loss and metabolic improvement.
Approach & results: 196 patients with advanced NASH underwent bariatric surgery, 66 of whom agreed to a follow-up liver biopsy at 6±3 years (36 with advanced fibrosis (AF) and 30 with high activity (HA) grade without AF). Liver biopsies were centrally read and histological response was defined as disappearance of advanced fibrosis or high activity. Bariatric surgery induced major histological improvement: 29% of patients had normal histology at follow-up biopsy; 74% had NASH resolution without fibrosis progression; 70% had ≥1 stage fibrosis regression. However, AF persisted in 47% of patients despite NASH resolution and some degree of fibrosis reversal, only evidenced by the EPOS-7 tier staging. These patients had lower weight-loss and reduced hypertension or diabetes remission rates. Older age and sleeve gastrectomy were the only independent predictors for persistent AF after adjustment for duration of follow-up. All HA patients had major histological improvement: 50% normal histology, 80% NASH resolution and 86% a ≥1 grade steatosis reduction. Patients with normal liver at follow-up had the largest weight-loss and metabolic improvement. Independent predictors of normal liver were the amount of weight-loss, high histological activity and the absence of advanced fibrosis before surgery.
Conclusions: While bariatric surgery successfully reverses active steatohepatitis, advanced fibrosis can persist for many years and is associated with lesser weight-loss and metabolic improvement. Weight-loss alone may not be sufficient to reverse advanced fibrosis.