Liver Function in Patients With Nonalcoholic Fatty Liver Disease Randomized to Roux-en-Y Gastric Bypass Versus Sleeve Gastrectomy A Secondary Analysis of a Randomized Clinical Trial

Objectives: The aim of the study was to compare the influence of sleeve gastrectomy (SG) versus Roux-en-Y gastric bypass (RYGB) on liver function in bariatric patients with non-alcoholic fatty liver disease (NAFLD) in a randomized clinical trial (NCT01806506). Background: Rapid weight loss and malabsorption after bariatric surgery in patients with NAFLD or steatohepatitis (NASH) may impair liver function. Methods: Sixty-six morbidly obese patients randomized to SG or RYGB were included in a secondary outcome analysis. Intraoperative liver biopsies were categorized with NAFLD Activity Score (NAS) and liver function tests were done before surgery and after 1, 6 and 12 months. Results: NASH was present in 54.5% RYGB and 51.5% SG patients (P > 0.05). At 12 months excess weight loss was 68.7 +/- 19.7% after SG and 62.8 +/- 18.5% after RYGB (P > 0.05). At 1 month international normalized ratio (INR) increased after RYGB (0.98 +/- 0.05 vs 1.14 +/- 0.11; P < 0.05) and SG (0.99 +/- 0.06 vs 1.04 +/- 0.06; P < 0.05), RYGB induced significantly greater increase in INR in the whole group and NASH patients than SG. After RYGB albumin decreased at 1 month (41.2 +/- 2.7 vs 39.0 +/- 3.2 g/L; P < 0.05). At 12 months, INR and albumin returned to baseline. At 12 months in NASH group, SG induced significant improvement in aspartate aminotransferase (32.4 +/- 17.4 vs 21.5 +/- 6.9U/L), alanine aminotransferase (39.9 +/- 28.6U/L vs 23.8 +/- 14.1U/L), gamma-glutamyl transpeptidase (34.3 +/- 16.6 vs 24.5 +/- 16.8U/L), and lactate dehydrogenase (510.8 +/- 33 vs 292.4 +/- 29). Variables predictive of INR change after 1 month included operation type, NAS >= 5, bilirubin, body mass index, hemoglobin A1C, and dyslipidemia. Conclusions: Patients with NASH undergoing RYGB are more susceptible to early transient deterioration of liver function than after SG.