Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Mental Health Services, VA Maine Healthcare System, 1 VA Center, Augusta, ME, 04330, USA.
Obes Surg. 2021 Aug;31(8):3700-3706. doi: 10.1007/s11695-021-05483-x. Epub 2021 May 22.
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.
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.
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.
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.
接受减重手术的个体由于酒精代谢的药代动力学变化和交叉成瘾，发生酒精使用问题的风险更高。关于接受减重手术且最终需要接受肝移植的酒精相关肝病（ALD）患者，相关数据很少。本项目的目的是更好地了解因 ALD 接受肝移植的减重手术后患者的人口统计学、医学和心理特征。
本回顾性临床队列研究在三个学术医疗中心，确定了在 10 年时间内有 1416 名接受 ALD 肝移植的患者。对电子病历进行了患者特征回顾，包括性别、年龄、体重指数、手术日期、终末期肝病模型（MELD）评分、病史、精神病史和死亡率。
在肝移植患者样本中，有 1.3%的患者在移植前接受过减重手术。在接受减重手术的患者样本中，有 50%为女性。与非减重手术患者相比，在减重手术亚组中，MELD 评分更高，且移植时年龄更小。有减重手术史的患者中更常见心境和焦虑障碍，其中重度抑郁症在亚组之间差异最大。
在因 ALD 而需要肝移植的患者中，有减重手术史的患者更可能为女性、更年轻，且被诊断为心境障碍。需要进一步进行更大、更多样本的研究，以更好地了解如何预防减重手术人群发生酒精使用障碍。
