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The Clinical Relevance of Prior Metabolic and Bariatric Surgery in Alcohol-Related Liver Disease in a Nationwide Belgian Liver Transplant Population

par Lefere, Sander;Troisi, Roberto Ivan Van R.I.;Karam, Vincent;Fondevila, Constantino;Nevens, Frederik;Verbeek, Jef;Detry, Olivier;Lanthier, Nicolas;Serenari, Matteo;Wiering, Leke;Vanwolleghem, Thomas;Moreno, Christophe ;Berrevoet, Frederik;Geerts, Anja
Référence Liver international, 45, 1, e16219
Publication Publié, 2025-01-01

Article révisé par les pairs

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Résumé :

Background and Aims: Patients with a history of metabolic and bariatric surgery (MBS) are susceptible to developing alcohol use disorder. Outcome after transplantation for alcohol-related liver disease (ALD) has not been studied in-depth. Methods: We included adult patients who underwent a liver transplantation (LT) in Belgium between 1 January 2013 and 31 December 2022 for ALD. We captured all patients with a history of MBS prior to developing ALD, and included non-MBS patients for comparison. Results: We identified 39 patients who underwent MBS before developing ALD, and included 443 non-MBS patients with an LT for ALD as controls. The median time between MBS and diagnosis of severe liver disease was 7.2 years. MBS patients were 9 years younger at the time of transplantation (p < 0.001). Pre-LT hepatocellular carcinoma was more prevalent in the non-MBS group (p < 0.001), while severe bacterial infections occurred more frequently in those with prior MBS. Importantly, patients with MBS had a lower survival after LT in age- and sex-adjusted Cox regression analysis (HR 2.205, p = 0.023). Liver disease was listed in 70.0% versus 13.3% of patients as the main cause of death. Liver-related mortality was linked to alcohol use relapse post-LT, with significantly more MBS patients experiencing relapse (30.8% vs. 13.3%, p = 0.003). Conclusion: Following MBS, excessive alcohol use can progress to end-stage ALD and need for LT. These patients present at a younger age, with more signs of hepatic decompensation, and can be at a higher risk for post-LT mortality, especially liver-related death.