Persistence of severe liver fibrosis despite substantial weight loss with bariatric surgery
Abstract
BACKGROUND AND 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 AND RESULTS: One hundred ninety-six 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 LBs were centrally read and histological response was defined as the disappearance of AF or HA. Bariatric surgery induced major histological improvement: 29% of patients had normal histology at follow-up biopsy; 74% had NASH resolution without fibrosis progression; and 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 seven-tier staging classification. 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 amount of weight loss, high histological activity, and the absence of AF before surgery. CONCLUSIONS: Although bariatric surgery successfully reverses active steatohepatitis, AF can persist for many years and is associated with lesser weight loss and metabolic improvement. Weight loss alone may not be sufficient to reverse AF.
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In distinct groups of patients, bariatric surgery may neither halt MASLD progression nor suffice to reverse advanced fibrosis.
“However, in distinct groups of patients, bariatric surgery may neither halt MASLD progression nor suffice to reverse advanced fibrosis [87].”
From Obesity and MASLD: Is weight loss the (only) key to treat metabolic liver disease? (2024) · cites this paper as [87]
Advanced fibrosis (bridging fibrosis or cirrhosis) persisted in 47% of individuals sometimes even 5 years or more post-surgery and despite significant weight loss.
“However, in a study with control biopsies after surgery, advanced fi brosis (bridging fi brosis or cirrhosis) persisted in 47% of individuals sometimes even 5 years or more post-surgery and despite signi fi cant weight loss.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [442]
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- Authors
- Pais, R., Aron‐Wisnewsky, J., Bedossa, P., Ponnaiah, M., Oppert, J., Siksik, J., Genser, L., Charlotte, F., Thabut, D., Clement, K., & Ratziu, V.
- Affiliations
- Inserm (FR)
- INSERM UMRS 1138 CRC,Paris,France
- Fondation pour l’innovation en Cadiométabolisme et Nutrition (FR)
- Sorbonne Université (FR)
- Assistance Publique – Hôpitaux de Paris (FR)
- Assistance Publique Hôpitaux De Paris,Hôpital Pitié‐Salpêtrière,Paris,France
- Corresponding author
- Ratziu, Vlad
- ORCID
- Venue
- Hepatology
- Published
- 2022-03-19
- Volume
- 76
- Issue
- 2
- Pages
- 456-468
- ISSN
- 0270-9139 (ISSN-L)
- 1527-3350
- OpenAlex
- W4207027817
- Cited by
- 95
- References
- 36
- Citations by year
- 2026: 29 · 2025: 20 · 2024: 27 · 2023: 13 · 2022: 5
- FWCI
- 11.73
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Hepatology (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion)
- Funders
- Agence Nationale de la Recherche (ANR-10-IAHU-0005)
- Topics
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Hepatology › Liver physiology and pathology
- Keywords
- bariatric surgery, nonalcoholic steatohepatitis, liver fibrosis, advanced fibrosis, weight loss, histological response, steatosis, sleeve gastrectomy, hypertension remission, diabetes remission
- MeSH terms
- Biopsy, Fibrosis, Humans, Liver, Liver Cirrhosis, Obesity, Morbid, Weight Loss, Bariatric Surgery, Non-alcoholic Fatty Liver Disease
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