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Liver Transplantation After Bariatric Surgery: a Clinical Cohort Study

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Abstract

Purpose

Individuals that undergo bariatric surgery are at higher risk for problematic alcohol use via pharmacokinetic changes in alcohol metabolism and cross addictions. Little data exists regarding post-bariatric surgery patients with alcohol-related liver disease (ALD) who ultimately require liver transplantation. The aim of this project was to better understand demographic, medical, and psychological characteristics of post-bariatric surgery patients who undergo liver transplantation due to ALD.

Methods

This retrospective clinical cohort identified 1416 patients who underwent ALD liver transplantation over a 10-year timespan at three academic medical centers. Electronic medical records were reviewed for patient characteristics, including sex, age, body mass index, surgery dates, Model for End Stage Liver Disease (MELD) scores, medical history, psychiatric history, and mortality rates.

Results

Within the sample of liver transplantation patients, 1.3% had undergone bariatric surgery prior to transplantation. Fifty percent of the post-bariatric surgery sample was female. The MELD score was higher and the median age at transplantation was younger in the post-bariatric surgery subgroup in comparison to that in the non-bariatric surgery patients. Mood and anxiety disorders were more common among those with a history of having bariatric surgery, with major depressive disorder having the largest difference between subgroups.

Conclusions

Among patients who require a liver transplantation due to ALD, those with a history of bariatric surgery are more likely to be female, younger, and diagnosed with mood disorders. Further studies with larger and more diverse samples are necessary to better understand how to prevent development of alcohol use disorder in the bariatric surgery population.

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Author notes

  1. Rachel E. Goetze

    Present address: Mental Health Services, VA Maine Healthcare System, 1 VA Center, Augusta, ME, 04330, USA

Authors and Affiliations

  1. Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    David C. Fipps, Rachel E. Goetze, Matthew M. Clark, Sheila G. Jowsey-Gregoire & Karen Grothe

  2. Department of Internal Medicine (Division of Endocrinology), Mayo Clinic, Rochester, MN, 55905, USA

    Matthew M. Clark & Karen Grothe

  3. Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, 55905, USA

    Kristin Mara

  4. Department of Medicine (Division of Gastroenterology and Hepatology), Mayo Clinic, Rochester, MN, 55905, USA

    Kymberly D. Watt

  5. Department of Surgery, Mayo Clinic, Rochester, MN, 55905, USA

    Sheila G. Jowsey-Gregoire & Julie K. Heimbach

Authors
  1. David C. Fipps
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Corresponding author

Correspondence to David C. Fipps.

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For this type of study, formal consent is not required.

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Informed consent does not apply.

Conflict of Interest

Matthew M. Clark, Ph.D., is a consultant for Roche Diabetes Care GmbH. All other authors declare that they have no potential conflicts of interest.

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Key Points

• Individuals that undergo bariatric surgery are at higher risk for problematic alcohol use via pharmacokinetic changes in alcohol metabolism and cross addictions.

• Little data exists regarding post-bariatric surgery patients with alcohol-related liver disease (ALD) who ultimately require liver transplantation.

• From the results of this retrospective clinical cohort: Among patients who require a liver transplantation due to ALD, those with a history of bariatric surgery are more likely to be younger, be female, have higher MELD scores, and be diagnosed with mood disorders.

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Fipps, D.C., Goetze, R.E., Clark, M.M. et al. Liver Transplantation After Bariatric Surgery: a Clinical Cohort Study. OBES SURG 31, 3700–3706 (2021). https://doi.org/10.1007/s11695-021-05483-x

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  • DOI: https://doi.org/10.1007/s11695-021-05483-x

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