It remains unclear to what extent and which components of advanced
liver disease improve after
bariatric surgery. We herein describe the histological outcome in patients with advanced NASH and its relationship with
weight loss and metabolic improvement.
APPROACH AND RESULTS: One hundred ninety-six patients with advanced NASH underwent
bariatric surgery, 66 of whom agreed to a follow-up liver biopsy at 6 ± 3 years (36 with advanced
fibrosis [AF] and 30 with high activity [HA] grade without AF). Liver biopsies LBs were centrally read and histological response was defined as the disappearance of AF or HA.
Bariatric surgery induced major histological improvement: 29% of patients had normal histology at follow-up biopsy; 74% had NASH resolution without
fibrosis progression; and 70% had ≥1 stage
fibrosis regression. However, AF persisted in 47% of patients despite NASH resolution and some degree of
fibrosis reversal, only evidenced by the EPoS seven-tier staging classification. These patients had lower
weight loss and reduced
hypertension or diabetes remission rates. Older age and sleeve
gastrectomy were the only independent predictors for persistent AF after adjustment for duration of follow-up. All HA patients had major histological improvement: 50% normal histology, 80% NASH resolution, and 86% a ≥1 grade steatosis reduction. Patients with normal liver at follow-up had the largest
weight loss and metabolic improvement. Independent predictors of normal liver were amount of
weight loss, high histological activity, and the absence of AF before surgery.
CONCLUSIONS: