A recent study from the Cleveland Clinic published in Nature Medicine demonstrates that bariatric surgery significantly lowers the risk of severe liver complications in obese patients suffering from cirrhosis linked to fatty liver disease. The study, led by Dr. Ali Aminian, suggests that bariatric surgery should be considered a viable treatment option for patients with both cirrhosis and obesity.
Impact of Bariatric Surgery on Liver Disease Progression
The study revealed that bariatric surgery was associated with a 72% reduction in the risk of developing serious liver complications and an 80% decrease in the risk of progressing to the decompensated stage among patients with compensated cirrhosis and obesity. This is particularly significant given the limited treatment options currently available for this patient population.
MASH and the Need for Effective Therapies
Obesity and diabetes are major drivers of metabolic dysfunction-associated steatohepatitis (MASH), the most prevalent form of chronic liver disease in the United States. MASH can lead to cirrhosis, a condition affecting an estimated three million Americans. Dr. Sobia Laique, a transplant hepatologist at Cleveland Clinic, emphasized the urgent need for effective therapies, as current interventions have not proven effective in mitigating the risk of severe liver complications in patients with compensated MASH-related cirrhosis.
The SPECCIAL Study: A 15-Year Outcome Analysis
The Surgical Procedures Eliminate Compensated Cirrhosis In Advancing Long-term (SPECCIAL) study compared outcomes of 62 obese Cleveland Clinic patients with compensated MASH-related cirrhosis who underwent bariatric surgery against a control group of 106 nonsurgical patients over a 15-year period. The results indicated that 20.9% of the surgical group developed major liver complications (including liver cancer and death) compared to 46.4% in the nonsurgical group.
Furthermore, progression from compensated to decompensated cirrhosis occurred in 15.6% of the surgical group versus 30.7% of the nonsurgical group over the 15-year follow-up. Patients in the bariatric surgery group experienced a 26.6% weight loss (31.6 kg), while the nonsurgical control group lost 9.8% (10.7 kg).
Expert Commentary and Future Directions
Dr. Steven Nissen, Chief Academic Officer of the Heart, Vascular and Thoracic Institute at Cleveland Clinic, noted that lifestyle interventions, the current standard recommendation, often fail to achieve the necessary weight loss and metabolic changes to reduce liver complication risks. The SPECCIAL study highlights bariatric surgery as an effective treatment to alter the course of cirrhosis progression in select patients.
The authors highlight that the SPECCIAL study is the first to examine long-term clinical outcomes following bariatric surgery in patients with MASH-related cirrhosis. Future research will explore the potential of new anti-obesity medications to provide similar benefits in this patient group.
