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Liver Decompensation after Bariatric Surgery in the Absence of Cirrhosis

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Abstract

Purpose

Metabolic dysfunction–associated fatty liver disease–related cirrhosis is possible at the time of bariatric surgery, complicated by further liver decompensation. Hepatic decompensation can also occur in the absence of cirrhosis but the presentation is less clear.

Methods

We analyze the clinical characteristics, histological findings, and management of patients without cirrhosis who developed hepatic decompensation after bariatric surgery in our single tertiary-care hospital.

Results

From 2014 to 2019, 6 patients underwent a transvenous liver biopsy for liver decompensation after bariatric surgery. Mean age at diagnosis was 44 years. The time between bariatric surgery and the onset of symptoms varied widely (min. 8 months, max. 17 years). Mean % of weight loss was high at 43%. The clinical presentation was as follows: fatigue and jaundice (5/6), leg edema (3/6), and ascites (1/6). Blood test showed increased transaminases (mean ALT 53 UI/L, mean AST 130 UI/L), bilirubin (mean 6 mg/dL), and INR (mean 1.5) with a low albumin level (mean 27 mg/dL). The hepatic venous pressure gradient was high (mean 10 mmHg). Histology revealed steatosis, hepatocyte ballooning but also portal inflammation with polymorphonuclear cells, and bile duct alterations. Mean fibrosis score was 2. The clinical course was favorable with nutritional support with a mean follow-up of 36 months.

Conclusion

Liver decompensation in the absence of cirrhosis can occur after bariatric surgery with a highly variable delay. A special histological signature is present with the coexistence of steatosis, bile duct alterations, and portal inflammation. Substantial clinical improvement with appropriate nutritional support seems to be effective.

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Acknowledgements

Nicolas Lanthier is a post-doctoral researcher from the Fonds de la Recherche Scientifique (FNRS), Belgium.

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Authors and Affiliations

  1. Service d’Hépato-Gastroentérologie, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium

    Perrine Vande Berg, Graziella de Broqueville, Bénédicte Delire, Peter Stärkel & Nicolas Lanthier

  2. Service de Médecine Interne Générale, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium

    Artida Ulaj & Philippe Hainaut

  3. Service d’Hépato-Gastroentérologie, Hôpital de Jolimont, Haine-Saint-Paul, Belgium

    Marie de Vos

  4. Service d’Endocrinologie et de Nutrition, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium

    Jean-Paul Thissen

  5. Service d’Anatomie Pathologique, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium

    Mina Komuta & Paulina Henry

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  1. Perrine Vande Berg
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Correspondence to Nicolas Lanthier.

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Ethics Approval and Consent to Participate

The study was approved by the ethical committee (Commission d’éthique hospitalo-facultaire, Cliniques universitaires Saint-Luc, UCLouvain) with the following reference: 2021/16MAR/129. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of retrospective study, formal consent was not required.

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The authors declare no competing interests.

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Key Points

• Liver damage and decompensation can occur after bariatric surgery, even in the absence of cirrhosis.

• A special histological signature is present with the coexistence of steatosis, bile duct alterations, and portal inflammation.

• Severe weight loss, protein malnutrition, and bacterial overgrowth are a possible cause.

• The treatment is appropriate nutritional support.

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Vande Berg, P., Ulaj, A., de Broqueville, G. et al. Liver Decompensation after Bariatric Surgery in the Absence of Cirrhosis. OBES SURG 32, 1227–1235 (2022). https://doi.org/10.1007/s11695-022-05930-3

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  • DOI: https://doi.org/10.1007/s11695-022-05930-3

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