Metabolic bariatric surgery is associated with reduced adverse hepatic and extrahepatic outcomes, and lower all-cause mortality, in patients with steatotic liver disease.


Stupalkowska, Weronika ORCID: 0000-0003-1230-7651, Henney, Alexander ORCID: 0000-0002-8066-9470, Sheu, Eric G, Alam, Uazman ORCID: 0000-0002-3190-1122 and Cuthbertson, Daniel J ORCID: 0000-0002-6128-0822 (2026) Metabolic bariatric surgery is associated with reduced adverse hepatic and extrahepatic outcomes, and lower all-cause mortality, in patients with steatotic liver disease. Diabetes, obesity & metabolism, 28 (1). pp. 174-185. ISSN 1462-8902, 1463-1326

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Abstract

<h4>Aim</h4>Metabolic bariatric surgery (MBS) improves histological endpoints in steatotic liver disease (SLD), but data on longer-term clinical outcomes in this population are scarce. Here, we assessed the impact of MBS on hepatic and extrahepatic morbidity and mortality in individuals with SLD.<h4>Methods</h4>Patients with SLD, with/without a history of MBS (MBS/no-MBS cohorts, respectively) between 01/01/2004 and 31/10/2019, were identified using the TriNetX platform. Cohorts were balanced with propensity score matching (PSM). Maximum follow-up was set to 5 years. The primary outcome was a composite of major adverse liver outcomes (MALO): cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, and liver transplant. Secondary outcomes included major cardiovascular (MACE) and kidney (MAKE) adverse events, obesity-associated cancers, and all-cause mortality (ACM). We performed sub-group analyses according to sex, MBS type, and risk factors (BMI ≥50 kg/m2 and type 2 diabetes (T2D)).<h4>Results</h4>We identified 15,262 and 540,031 patients (for the MBS and no-MBS cohorts, respectively); 14,970 patients/cohort after PSM (mean age: 46.7 vs. 47.4; female: 74.3% vs. 75.7%; mean follow-up, 4.1 years). MBS was associated with reduced HR of MALO (0.84, 95% CI 0.75-0.95), MACE (0.52, CI 0.47-0.57), MAKE (0.54, CI 0.41-0.72), obesity-related cancers (0.58, CI 0.50-0.67), and ACM (0.49, 0.43-0.56). In subgroup analyses, MBS was associated with reduced HR of MALO, MACE, MAKE, obesity-related cancers, and ACM in females, patients with T2D, BMI > 50 kg/m2 and irrespective of surgery type.<h4>Conclusion</h4>In patients with SLD, MBS is associated with significant reductions in the rates of adverse hepatic and extrahepatic outcomes and all-cause mortality over 4 years' follow-up.

Item Type: Article
Uncontrolled Keywords: Humans, Fatty Liver, Diabetes Mellitus, Type 2, Obesity, Morbid, Treatment Outcome, Cause of Death, Risk Factors, Adult, Middle Aged, Female, Male, Bariatric Surgery, Propensity Score
Divisions: Faculty of Health & Life Sciences
Faculty of Health & Life Sciences > Inst. Life Courses & Medical Sciences
Faculty of Health & Life Sciences > Inst. Life Courses & Medical Sciences > Inst. Life Courses & Medical Sciences (T&R staff)
Faculty of Health & Life Sciences > Inst. Life Courses & Medical Sciences > Cardiovascular & Metabolic Medicine
Depositing User: Symplectic Admin
Date Deposited: 05 Nov 2025 15:41
Last Modified: 06 Dec 2025 03:06
DOI: 10.1111/dom.70173
Open Access URL: https://doi.org/10.1111/dom.70173
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URI: https://livrepository.liverpool.ac.uk/id/eprint/3195241
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