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

Lefere, Sander;Troisi, Roberto Ivan;Karam, Vincent;Fondevila, Constantino;Geerts, Anja;et.al.
(2025) Liver international : official journal of the International Association for the Study of the Liver — Vol. 45, n° 1, p. e16219 (2025)

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  • Lefere, Sanderorcid-logo
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  • Troisi, Roberto Ivan
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  • Karam, Vincent
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  • Fondevila, Constantino
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  • Lanthier, Nicolasorcid-logoUCLouvain
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  • Geerts, Anja
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Abstract
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. 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. 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). 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.
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Lefere, S., Troisi, R. I., Karam, V., Fondevila, C., Nevens, F., Verbeek, J., Detry, O., Lanthier, N., Serenari, M., Wiering, L., Vanwolleghem, T., Moreno, C., Berrevoet, F., & Geerts, A. (2025). The Clinical Relevance of Prior Metabolic and Bariatric Surgery in Alcohol-Related Liver Disease in a Nationwide Belgian Liver Transplant Population. Liver international : official journal of the International Association for the Study of the Liver, 45(1), e16219. https://doi.org/10.1111/liv.16219 (Original work published 2025)