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Erschienen in: Obesity Surgery 11/2015

01.11.2015 | Original Contributions

Functional Liver Recovery After Bariatric Surgery—a Prospective Cohort Study with the LiMAx Test

verfasst von: Patrick H. Alizai, Janica Wendl, Anjali A. Roeth, Christian D. Klink, Tom Luedde, Inga Steinhoff, Ulf P. Neumann, Maximilian Schmeding, Florian Ulmer

Erschienen in: Obesity Surgery | Ausgabe 11/2015

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Abstract

Background

Bariatric surgery provides long-term weight loss and improvement of obesity-associated diseases such as nonalcoholic steatohepatitis (NASH). Histologic improvement of NASH has been reported in some studies after bariatric surgery. This study was designed to assess the liver function in obese patients as well as its recovery after bariatric surgery with a noninvasive test method.

Methods

In a prospective cohort study from October 2011 to May 2014, morbidly obese individuals receiving bariatric surgery were investigated for functional liver recovery (n = 34). Liver function was determined by the LiMAx test (enzymatic capacity of cytochrome P450 1A2) preoperatively, 6 and 12 months postoperatively. Liver biopsy specimens were obtained from 18 participants and classified according to the nonalcoholic fatty liver disease (NAFLD) activity score (NAS).

Results

The mean age of participants was 44 years, and the mean body mass index (BMI) was 52 kg/m2. The mean percent excess BMI loss (%EBMIL) was 53 % after 6 months and 68 % after 1 year. Mean liver function capacity increased significantly from 255 μg/kg/h preoperative to 324 μg/kg/h after 6 months and 342 μg/kg/h after 12 months. A negative correlation was observed between %EBMIL and alteration of liver function capacity in the first 6 months. Finally, the median NAS showed a negative correlation with liver function capacity.

Conclusions

Bariatric surgery leads to a significant functional recovery of the liver. An initial marked weight loss may negatively influence functional liver recovery.
Literatur
1.
Zurück zum Zitat Yatsuya H, Li Y, Hilawe EH, et al. Global trend in overweight and obesity and its association with cardiovascular disease incidence. Circ J. 2014;78:2807–18.CrossRefPubMed Yatsuya H, Li Y, Hilawe EH, et al. Global trend in overweight and obesity and its association with cardiovascular disease incidence. Circ J. 2014;78:2807–18.CrossRefPubMed
2.
Zurück zum Zitat Guh DP, Zhang W, Bansback N, et al. The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health. 2009;9. Guh DP, Zhang W, Bansback N, et al. The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health. 2009;9.
3.
Zurück zum Zitat Runkel N, Colombo-Benkmann M, Huttl TP, et al. Evidence-based German guidelines for surgery for obesity. Int J Color Dis. 2011;26:397–404.CrossRef Runkel N, Colombo-Benkmann M, Huttl TP, et al. Evidence-based German guidelines for surgery for obesity. Int J Color Dis. 2011;26:397–404.CrossRef
5.
Zurück zum Zitat Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes-3-year outcomes. N Engl J Med. 2014;370:2002–13.CrossRefPubMed Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes-3-year outcomes. N Engl J Med. 2014;370:2002–13.CrossRefPubMed
6.
Zurück zum Zitat Angulo P. Medical progress—nonalcoholic fatty liver disease. N Engl J Med. 2002;346:1221–31.CrossRefPubMed Angulo P. Medical progress—nonalcoholic fatty liver disease. N Engl J Med. 2002;346:1221–31.CrossRefPubMed
7.
Zurück zum Zitat Younossi ZM, Gorreta F, Ong JP, et al. Hepatic gene expression in patients with obesity-related non-alcoholic steatohepatitis. Liver Int. 2005;25:760–71.CrossRefPubMed Younossi ZM, Gorreta F, Ong JP, et al. Hepatic gene expression in patients with obesity-related non-alcoholic steatohepatitis. Liver Int. 2005;25:760–71.CrossRefPubMed
8.
Zurück zum Zitat Lebovics E, Rubin J. Non-alcoholic fatty liver disease (NAFLD): why you should care, when you should worry, what you should do. Diabetes Metab Res Rev. 2011;27:419–24.CrossRefPubMed Lebovics E, Rubin J. Non-alcoholic fatty liver disease (NAFLD): why you should care, when you should worry, what you should do. Diabetes Metab Res Rev. 2011;27:419–24.CrossRefPubMed
9.
Zurück zum Zitat Farrell GC, Larter CZ. Nonalcoholic fatty liver disease: from steatosis to cirrhosis. Hepatology. 2006;43:S99–112.CrossRefPubMed Farrell GC, Larter CZ. Nonalcoholic fatty liver disease: from steatosis to cirrhosis. Hepatology. 2006;43:S99–112.CrossRefPubMed
10.
Zurück zum Zitat Fried M, Hainer V, Basdevant A, et al. Inter-disciplinary European guidelines on surgery of severe obesity. Int J Obes. 2007;31:569–77. Fried M, Hainer V, Basdevant A, et al. Inter-disciplinary European guidelines on surgery of severe obesity. Int J Obes. 2007;31:569–77.
11.
Zurück zum Zitat Sjostrom L. Review of the key results from the Swedish Obese Subjects (SOS) trial—a prospective controlled intervention study of bariatric surgery. J Intern Med. 2013;273:219–34.CrossRefPubMed Sjostrom L. Review of the key results from the Swedish Obese Subjects (SOS) trial—a prospective controlled intervention study of bariatric surgery. J Intern Med. 2013;273:219–34.CrossRefPubMed
12.
Zurück zum Zitat Rabl C, Campos GM. The impact of bariatric surgery on nonalcoholic steatohepatitis. Semin Liver Dis. 2012;32:80–91.CrossRefPubMed Rabl C, Campos GM. The impact of bariatric surgery on nonalcoholic steatohepatitis. Semin Liver Dis. 2012;32:80–91.CrossRefPubMed
13.
Zurück zum Zitat Buchwald H, Estok R, Fahrbach K, et al. Trends in mortality in bariatric surgery: a systematic review and meta-analysis. Surgery. 2007;142:621–32.CrossRefPubMed Buchwald H, Estok R, Fahrbach K, et al. Trends in mortality in bariatric surgery: a systematic review and meta-analysis. Surgery. 2007;142:621–32.CrossRefPubMed
14.
Zurück zum Zitat Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122:248–56.CrossRefPubMed Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122:248–56.CrossRefPubMed
15.
Zurück zum Zitat Hafeez S, Ahmed MH. Bariatric surgery as potential treatment for nonalcoholic fatty liver disease: a future treatment by choice or by chance? J Obes. 2013;2013:839275.PubMedCentralCrossRefPubMed Hafeez S, Ahmed MH. Bariatric surgery as potential treatment for nonalcoholic fatty liver disease: a future treatment by choice or by chance? J Obes. 2013;2013:839275.PubMedCentralCrossRefPubMed
16.
Zurück zum Zitat Strassburg CP, Manns MP. Approaches to liver biopsy techniques—revisited. Semin Liver Dis. 2006;26:318–27.CrossRefPubMed Strassburg CP, Manns MP. Approaches to liver biopsy techniques—revisited. Semin Liver Dis. 2006;26:318–27.CrossRefPubMed
17.
Zurück zum Zitat Assy N, Minuk GY. Liver regeneration: methods for monitoring and their applications. J Hepatol. 1997;26:945–52.CrossRefPubMed Assy N, Minuk GY. Liver regeneration: methods for monitoring and their applications. J Hepatol. 1997;26:945–52.CrossRefPubMed
18.
Zurück zum Zitat Lock JF, Malinowski M, Seehofer D, et al. Function and volume recovery after partial hepatectomy: influence of preoperative liver function, residual liver volume, and obesity. Langenbecks Arch Surg. 2012;397:1297–304.CrossRefPubMed Lock JF, Malinowski M, Seehofer D, et al. Function and volume recovery after partial hepatectomy: influence of preoperative liver function, residual liver volume, and obesity. Langenbecks Arch Surg. 2012;397:1297–304.CrossRefPubMed
19.
Zurück zum Zitat Hoekstra LT, de Graaf W, Nibourg GAA, et al. Physiological and biochemical basis of clinical liver function tests: a review. Ann Surg. 2013;257:27–36.CrossRefPubMed Hoekstra LT, de Graaf W, Nibourg GAA, et al. Physiological and biochemical basis of clinical liver function tests: a review. Ann Surg. 2013;257:27–36.CrossRefPubMed
20.
Zurück zum Zitat Stockmann M, Lock JF, Riecke B, et al. Prediction of postoperative outcome after hepatectomy with a new bedside test for maximal liver function capacity. Ann Surg. 2009;250:119–25.CrossRefPubMed Stockmann M, Lock JF, Riecke B, et al. Prediction of postoperative outcome after hepatectomy with a new bedside test for maximal liver function capacity. Ann Surg. 2009;250:119–25.CrossRefPubMed
21.
Zurück zum Zitat Stockmann M, Lock JF, Malinowski M, et al. The LiMAx test: a new liver function test for predicting postoperative outcome in liver surgery. HPB. 2010;12:139–46.PubMedCentralCrossRefPubMed Stockmann M, Lock JF, Malinowski M, et al. The LiMAx test: a new liver function test for predicting postoperative outcome in liver surgery. HPB. 2010;12:139–46.PubMedCentralCrossRefPubMed
22.
Zurück zum Zitat Lock JF, Schwabauer E, Martus P, et al. Early diagnosis of primary nonfunction and indication for reoperation after liver transplantation. Liver Transpl. 2010;16:172–80.CrossRefPubMed Lock JF, Schwabauer E, Martus P, et al. Early diagnosis of primary nonfunction and indication for reoperation after liver transplantation. Liver Transpl. 2010;16:172–80.CrossRefPubMed
23.
Zurück zum Zitat Kaffarnik MF, Lock JF, Vetter H, et al. Early diagnosis of sepsis-related hepatic dysfunction and its prognostic impact on survival: a prospective study with the LiMAx test. Crit Care. 2013;17(5):R259.PubMedCentralCrossRefPubMed Kaffarnik MF, Lock JF, Vetter H, et al. Early diagnosis of sepsis-related hepatic dysfunction and its prognostic impact on survival: a prospective study with the LiMAx test. Crit Care. 2013;17(5):R259.PubMedCentralCrossRefPubMed
24.
Zurück zum Zitat Kleiner DE, Brunt EM, Van Natta M, et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology. 2005;41:1313–21.CrossRefPubMed Kleiner DE, Brunt EM, Van Natta M, et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology. 2005;41:1313–21.CrossRefPubMed
25.
Zurück zum Zitat Longerich T, Flechtenmacher C, Schirmacher P. Quality and quantity in hepatopathology. Diagnostic and clinically relevant grading for non-tumourous liver diseases. Pathologe. 2008;29:15–26.CrossRefPubMed Longerich T, Flechtenmacher C, Schirmacher P. Quality and quantity in hepatopathology. Diagnostic and clinically relevant grading for non-tumourous liver diseases. Pathologe. 2008;29:15–26.CrossRefPubMed
26.
Zurück zum Zitat Barsic N, Lerotic I, Smircic-Duvnjak L, et al. Overview and developments in noninvasive diagnosis of nonalcoholic fatty liver disease. World J Gastroenterol. 2012;18:3945–54.PubMedCentralCrossRefPubMed Barsic N, Lerotic I, Smircic-Duvnjak L, et al. Overview and developments in noninvasive diagnosis of nonalcoholic fatty liver disease. World J Gastroenterol. 2012;18:3945–54.PubMedCentralCrossRefPubMed
27.
Zurück zum Zitat Ratziu V, Bellentani S, Cortez-Pinto H, et al. A position statement on NAFLD/NASH based on the EASL 2009 special conference. J Hepatol. 2010;53:372–84.CrossRefPubMed Ratziu V, Bellentani S, Cortez-Pinto H, et al. A position statement on NAFLD/NASH based on the EASL 2009 special conference. J Hepatol. 2010;53:372–84.CrossRefPubMed
28.
Zurück zum Zitat Daniel S, Ben-Menachem T, Vasudevan G, et al. Prospective evaluation of unexplained chronic liver transaminase abnormalities in asymptomatic and symptomatic patients. Am J Gastroenterol. 1999;94:3010–4.CrossRefPubMed Daniel S, Ben-Menachem T, Vasudevan G, et al. Prospective evaluation of unexplained chronic liver transaminase abnormalities in asymptomatic and symptomatic patients. Am J Gastroenterol. 1999;94:3010–4.CrossRefPubMed
29.
Zurück zum Zitat Sjostrom L, Narbro K, Sjostrom D, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741–52.CrossRefPubMed Sjostrom L, Narbro K, Sjostrom D, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741–52.CrossRefPubMed
30.
Zurück zum Zitat Chitturi S, Farrell GC. Etiopathogenesis of nonalcoholic steatohepatitis. Semin Liver Dis. 2001;21:27–41.CrossRefPubMed Chitturi S, Farrell GC. Etiopathogenesis of nonalcoholic steatohepatitis. Semin Liver Dis. 2001;21:27–41.CrossRefPubMed
31.
Zurück zum Zitat Tilg H, Diehl AM. Mechanisms of disease: cytokines in alcoholic and nonalcoholic steatohepatitis. N Engl J Med. 2000;343:1467–76.CrossRefPubMed Tilg H, Diehl AM. Mechanisms of disease: cytokines in alcoholic and nonalcoholic steatohepatitis. N Engl J Med. 2000;343:1467–76.CrossRefPubMed
32.
Zurück zum Zitat Chitturi S, Abeygunasekera S, Farrell GC, et al. NASH and insulin resistance: insulin hypersecretion and specific association with the insulin resistance syndrome. Hepatology. 2002;35:373–9.CrossRefPubMed Chitturi S, Abeygunasekera S, Farrell GC, et al. NASH and insulin resistance: insulin hypersecretion and specific association with the insulin resistance syndrome. Hepatology. 2002;35:373–9.CrossRefPubMed
33.
Zurück zum Zitat Mathurin P, Hollebecque A, Arnalsteen L, et al. Prospective study of the long-term effects of bariatric surgery on liver injury in patients without advanced disease. Gastroenterology. 2009;137:532–40.CrossRefPubMed Mathurin P, Hollebecque A, Arnalsteen L, et al. Prospective study of the long-term effects of bariatric surgery on liver injury in patients without advanced disease. Gastroenterology. 2009;137:532–40.CrossRefPubMed
34.
Zurück zum Zitat Barker KB, Palekar NA, Bowers SP, et al. Non-alcoholic steatohepatitis: effect of Roux-en-Y gastric bypass surgery. Am J Gastroenterol. 2006;101:368–73.CrossRefPubMed Barker KB, Palekar NA, Bowers SP, et al. Non-alcoholic steatohepatitis: effect of Roux-en-Y gastric bypass surgery. Am J Gastroenterol. 2006;101:368–73.CrossRefPubMed
35.
Zurück zum Zitat Moretto M, Kupski C, da Silva VD, et al. Effect of bariatric surgery on liver fibrosis. Obes Surg. 2012;22:1044–9.CrossRefPubMed Moretto M, Kupski C, da Silva VD, et al. Effect of bariatric surgery on liver fibrosis. Obes Surg. 2012;22:1044–9.CrossRefPubMed
36.
Zurück zum Zitat Verna EC, Berk PD. Role of fatty acids in the pathogenesis of obesity and fatty liver: impact of bariatric surgery. Semin Liver Dis. 2008;28:407–26.CrossRefPubMed Verna EC, Berk PD. Role of fatty acids in the pathogenesis of obesity and fatty liver: impact of bariatric surgery. Semin Liver Dis. 2008;28:407–26.CrossRefPubMed
37.
Zurück zum Zitat Kral JG, Thung SN, Biron S, et al. Effects of surgical treatment of the metabolic syndrome on liver fibrosis and cirrhosis. Surgery. 2004;135:48–58.CrossRefPubMed Kral JG, Thung SN, Biron S, et al. Effects of surgical treatment of the metabolic syndrome on liver fibrosis and cirrhosis. Surgery. 2004;135:48–58.CrossRefPubMed
38.
Zurück zum Zitat Ratziu V, Charlotte F, Heurtier A, et al. Sampling variability of liver biopsy in nonalcoholic fatty liver disease. Gastroenterology. 2005;128:1898–906.CrossRefPubMed Ratziu V, Charlotte F, Heurtier A, et al. Sampling variability of liver biopsy in nonalcoholic fatty liver disease. Gastroenterology. 2005;128:1898–906.CrossRefPubMed
39.
Zurück zum Zitat Mofrad P, Contos MJ, Haque M, et al. Clinical and histologic spectrum of nonalcoholic fatty liver disease associated with normal ALT values. Hepatology. 2003;37:1286–92.CrossRefPubMed Mofrad P, Contos MJ, Haque M, et al. Clinical and histologic spectrum of nonalcoholic fatty liver disease associated with normal ALT values. Hepatology. 2003;37:1286–92.CrossRefPubMed
40.
Zurück zum Zitat Verma S, Jensen D, Hart J, et al. Predictive value of ALT levels for non-alcoholic steatohepatitis (NASH) and advanced fibrosis in non-alcoholic fatty liver disease (NAFLD). Liver Int. 2013;33:1398–405.CrossRefPubMed Verma S, Jensen D, Hart J, et al. Predictive value of ALT levels for non-alcoholic steatohepatitis (NASH) and advanced fibrosis in non-alcoholic fatty liver disease (NAFLD). Liver Int. 2013;33:1398–405.CrossRefPubMed
41.
Zurück zum Zitat Fracanzani AL, Valenti L, Bugianesi E, et al. Risk of severe liver disease in nonalcoholic fatty liver disease with normal aminotransferase levels: a role for insulin resistance and diabetes. Hepatology. 2008;48:792–8.CrossRefPubMed Fracanzani AL, Valenti L, Bugianesi E, et al. Risk of severe liver disease in nonalcoholic fatty liver disease with normal aminotransferase levels: a role for insulin resistance and diabetes. Hepatology. 2008;48:792–8.CrossRefPubMed
42.
Zurück zum Zitat Saadeh S, Younossi ZM, Remer EM, et al. The utility of radiological imaging in nonalcoholic fatty liver disease. Gastroenterology. 2002;123:745–50.CrossRefPubMed Saadeh S, Younossi ZM, Remer EM, et al. The utility of radiological imaging in nonalcoholic fatty liver disease. Gastroenterology. 2002;123:745–50.CrossRefPubMed
43.
Zurück zum Zitat Wong VWS, Vergniol J, Wong GLH, et al. Diagnosis of fibrosis and cirrhosis using liver stiffness measurement in nonalcoholic fatty liver disease. Hepatology. 2010;51:454–62.CrossRefPubMed Wong VWS, Vergniol J, Wong GLH, et al. Diagnosis of fibrosis and cirrhosis using liver stiffness measurement in nonalcoholic fatty liver disease. Hepatology. 2010;51:454–62.CrossRefPubMed
44.
Zurück zum Zitat Yoneda M, Yoneda M, Fujita K, et al. Transient elastography in patients with non-alcoholic fatty liver disease (NAFLD) (vol 56, pg 1330, 2007). Gut. 2007;56:1800.CrossRef Yoneda M, Yoneda M, Fujita K, et al. Transient elastography in patients with non-alcoholic fatty liver disease (NAFLD) (vol 56, pg 1330, 2007). Gut. 2007;56:1800.CrossRef
45.
Zurück zum Zitat Foucher J, Castera L, Bernard PH, et al. Prevalence and factors associated with failure of liver stiffness measurement using FibroScan in a prospective study of 2114 examinations. Eur J Gastroenterol Hepatol. 2006;18:411–2.CrossRefPubMed Foucher J, Castera L, Bernard PH, et al. Prevalence and factors associated with failure of liver stiffness measurement using FibroScan in a prospective study of 2114 examinations. Eur J Gastroenterol Hepatol. 2006;18:411–2.CrossRefPubMed
Metadaten
Titel
Functional Liver Recovery After Bariatric Surgery—a Prospective Cohort Study with the LiMAx Test
verfasst von
Patrick H. Alizai
Janica Wendl
Anjali A. Roeth
Christian D. Klink
Tom Luedde
Inga Steinhoff
Ulf P. Neumann
Maximilian Schmeding
Florian Ulmer
Publikationsdatum
01.11.2015
Verlag
Springer US
Erschienen in
Obesity Surgery / Ausgabe 11/2015
Print ISSN: 0960-8923
Elektronische ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-015-1664-0

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