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20-02-2024 | Liver Transplantation | Original Contributions

Sleeve Gastrectomy Reduces the Need for Liver Transplantation in Patients with Obesity and Non-Alcoholic Steatohepatitis: a Predictive Model

Authors: Armaun D. Rouhi, Rose E. Castle, Gerard D. Hoeltzel, Noel N. Williams, Kristoffel R. Dumon, Maria Baimas-George, Michael Wachs, Trevor L. Nydam, Rashikh A. Choudhury

Published in: Obesity Surgery | Issue 4/2024

Abstract

Background

Non-alcoholic steatohepatitis (NASH) is one of the leading indications for liver transplantation (LT) in the United States. As with the current obesity epidemic, the incidence of NASH continues to rise. However, the impact of broad utilization of bariatric surgery (BS) for patients with NASH is unknown, particularly in regard to mitigating the need for LT.

Methods

Markov decision analysis was performed to simulate the lives of 20,000 patients with obesity and concomitant NASH who were deemed ineligible to be waitlisted for LT unless they achieved a body mass index (BMI) < 35 kg/m². Life expectancy following medical weight management (MWM) and sleeve gastrectomy (SG) were estimated. Base case patients were defined as having NASH without fibrosis and a pre-intervention BMI of 45 kg/m². Sensitivity analysis of initial BMI was performed.

Results

Simulated base case analysis patients who underwent SG gained 14.3 years of life compared to patients who underwent MWM. One year after weight loss intervention, 9% of simulated MWM patients required LT compared to only 5% of SG patients. Survival benefit for SG was observed above a BMI of 32.2 kg/m².

Conclusion

In this predictive model of 20,000 patients with obesity and concomitant NASH, surgical weight loss is associated with a reduction in the progression of NASH, thereby reducing the need for LT. A reduced BMI threshold of 32 kg/m² for BS may offer survival benefit for patients with obesity and NASH.

Graphical Abstract

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Title: Sleeve Gastrectomy Reduces the Need for Liver Transplantation in Patients with Obesity and Non-Alcoholic Steatohepatitis: a Predictive Model
Authors: Armaun D. Rouhi
Rose E. Castle
Gerard D. Hoeltzel
Noel N. Williams
Kristoffel R. Dumon
Maria Baimas-George
Michael Wachs
Trevor L. Nydam
Rashikh A. Choudhury
Publication date: 20-02-2024
Publisher: Springer US
Keywords: Liver Transplantation
Liver Transplantation
Liver Transplantation
Liver Transplantation
Liver Transplantation
Sleeve Gastrectomy
Bariatric Surgery
Bariatric Surgery
Obesity
Obesity
Published in: Obesity Surgery / Issue 4/2024
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-024-07102-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Sleeve Gastrectomy Reduces the Need for Liver Transplantation in Patients with Obesity and Non-Alcoholic Steatohepatitis: a Predictive Model

Abstract

Background

Methods

Results

Conclusion

Graphical Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Graphical Abstract

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