[en] [en] 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.
Disciplines :
Gastroenterology & hepatology Surgery
Author, co-author :
Lefere, Sander ; Hepatology Research Unit, Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium ; Liver Research Center Ghent, Ghent University, Ghent University Hospital, Ghent, Belgium
Troisi, Roberto Ivan; Division of HBP, Minimally Invasive and Robotic Surgery, Transplantation Service, Federico II University Hospital, Naples, Italy
Karam, Vincent; European Society for Organ Transplantation, Padova, Italy
Fondevila, Constantino; Department of General and Digestive Surgery, Hospital Universitario La Paz, CiberEHD, Madrid, Spain
Nevens, Frederik; Department of Hepatology, University Hospital Leuven, Leuven, Belgium
Verbeek, Jef; Department of Hepatology, University Hospital Leuven, Leuven, Belgium
Detry, Olivier ; Université de Liège - ULiège > Département des sciences cliniques > Pathologie chirurgicale abdominale et endocrinienne
Lanthier, Nicolas; Service d'Hépato-gastroentérologie, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
Serenari, Matteo ; Hepato-Biliary and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy ; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
Wiering, Leke ; Department of Hepatology and Gastroenterology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
Vanwolleghem, Thomas ; Division of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerp, Belgium ; Viral Hepatitis Research Group, Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
Moreno, Christophe; Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
Berrevoet, Frederik; Department of General and Hepatobiliary Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
Geerts, Anja; Hepatology Research Unit, Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium ; Liver Research Center Ghent, Ghent University, Ghent University Hospital, Ghent, Belgium
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