Bariatric surgery and the liver : mechanisms, benefits, and risks

The prevalence of obesity and metabolic diseases such as type 2 diabetes and nonalcoholic fatty liver disease (NAFLD) has risen dramatically over the past decades. At present, bariatric surgery is the most effective treatment for this global health problem, through effects on food intake, gut hormone secretion, metabolic signaling pathways, and adipose tissue dysfunction. The liver occupies a central role in carbohydrate, protein, and lipid metabolism. Notably, a reduction in hepatic fat content and an improvement in hepatic insulin resistance are among the earliest beneficial effects of bariatric surgery, which has therefore emerged as an attractive treatment option for NAFLD. However, as the scope and popularity of weight loss surgery have expanded, new questions have arisen regarding its safety in patients with liver cirrhosis, the outcome of liver transplantation in patients with a history of bariatric surgery, and over incidental reports of liver failure following surgery. Studies in humans and rodents have also linked bariatric surgery to an increased risk of developing alcohol use disorder, a major risk factor for liver disease. This review integrates data from clinical and translational research to delineate both the beneficial impact of bariatric surgery on the liver and the potential risks involved

Quality of life after liver transplantation : state of the art

Quality of life (QoL) after deceased donor liver transplantation is increasingly recognized as a major outcome parameter. We reviewed recent publications in this rapidly evolving field in order to summarize recent achievements in the field and to define opportunities and perspectives for research and improvement of patient care. QoL does improve after liver transplantation according to a typical pattern. During the first year, there is a significant improvement in QoL. After one year, the improvement does stabilise and tends to decline slightly. In addition to the physical condition, different psychological parameters (such as depression, anxiety, sexual function) and socio-demographic elements (professional state, sex, marital state) seem to impact QoL. Opportunities for further research are the use of dedicated questionnaires and identification of influencing factors for QoL

[image] Château et serres de Mr. le Chevalier Heynderycx, sénateur de Belgique.

Gravure, Onghena.Kasteel Heyndricks. (1820)Bijzondere collectiesArchitectuurfocu

Illness cognitions and health-related quality of life in liver transplant patients related to length of stay, comorbidities and complications

Purpose Illness cognitions regarding helplessness and acceptance are known to play a role in health-related quality of life (HRQoL). Our study examined the evolution of these illness cognitions and the physical (PQoL) and mental QoL (MQoL) in liver transplantation (LT) patients over time in relation to pre- and postoperative clinical factors. Methods We performed an analytical cross-sectional study using self-report questionnaires at 4 timeframes: preLT, postLT(0-3 m), postLT(1y), and postLT(2y). T-test was used to identify the influence of different clinical factors related to the LT on postLT(2y) QoL and illness cognition. Linear mixed models were used to determine evolution. Results PostLT patients showed significant less helplessness and more acceptance cognitions. PQoL and MQoL decreased postLT(0-3 m,) then started to increase and are highest at postLT(1y.) Patients with preLT ascites showed significantly less helplessness postLT(2y), while patients with a low preLT MELD score < 20 showed a significant better MQoL postLT(2y). Biliary complications and re-transplantation were associated with more helplessness and a worse PQoL postLT(1y-2y). Length of stay in ICU and hospital was negatively correlated with illness cognitions and PQoL and MQoL postLT(1y.) Conclusions Our findings confirm that liver transplant patients have improvement of illness cognitions and mental and physical HRQoL at 1 and 2 years after liver transplantation. A postoperative period without complications and with short stay in ICU and in hospital, is important to achieve PQoL and feeling less helpless, while the MQoL is influenced by acceptance and preLT PQoL. Multidisciplinary approach preLT and postLT should be standard care