The Link between Acute Liver Failure and Bariatric Surgery

BOSTON, Nov. 10, 2012 /PRNewswire/ -- Among patients with acetaminophen-induced acute liver failure (ALF), bariatric surgery was 25 times more common than in the general population.

Researchers at California Pacific Medical Center (CPMC) reported an alarming rate of bariatric surgery among patients with ALF from acetaminophen poisoning.  They studied 101 patients with ALF between 2009 and 2011, of whom 54 had acetaminophen-induced ALF. Of those 54 patients 9 – or 16.7 percent – had prior bariatric surgery, as compared to none of the 47 patients with ALF from other causes. The prevalence of bariatric surgery in the American population is approximately 0.66 percent.

When asked about the large percentage of patients with acetaminophen-induced ALF who had bariatric surgery, Dr. Edward Holt said, "While it is possible that this percentage could be lower in a study with a larger sample size, it is not likely that a difference this large would disappear.  To the best of our knowledge, this is the first report of bariatric surgery in acetaminophen-induced ALF."

In the United States more than one million adults between the ages of 18 and 75 years have had bariatric surgery. "If these patients are predisposed to liver injury from acetaminophen, then clinical management and drug advertising should immediately be updated to reflect this risk," said Dr. Holt.

When asked about future directions of research in this area, Dr. Holt said "We would like see these findings reproduced in a larger, multi-center study, and we want to look at the pharmacokinetics of acetaminophen in patients with and without bariatric surgery."

The CPMC researchers called attention to previously reported associations between bariatric surgery and suicide, and between alcohol abuse and acetaminophen-induced ALF.  They showed that patients in their study with prior bariatric surgery and acetaminophen-induced ALF did not have higher rates of depression, alcohol abuse, or intent to cause self-harm when compared to patients with other causes of ALF.

The authors concluded that prior bariatric surgery may place patients at higher risk for acetaminophen poisoning, similar to the increased risk seen in patients who chronically abuse alcohol.  "Patients with chronic alcohol abuse who take 4 grams of acetaminophen each day can inadvertently poison themselves and even develop acetaminophen-induced ALF.  Based on our results, we suspect that bariatric surgery may also render patients more susceptible to acetaminophen-induced liver injury.  However, before an official warning is issued further research should be conducted." concluded Dr. Holt.

Abstract title: 
Prior bariatric surgery increases the risk of acute liver failure from acetaminophen poisoning

AASLD is the leading medical organization for advancing the science and practice of hepatology. Founded by physicians in 1950, AASLD's vision is to prevent and cure liver diseases. This year's Liver Meeting®, held in Boston, Massachusetts November 9 – 13, will bring together more than 9,000 researchers from 55 countries.

A pressroom will be available from November 10 at the annual meeting. For copies of abstracts and press releases, or to arrange researcher interviews, contact Gregory Bologna at 703-299-9766.

Press releases and all abstracts are available online at www.aasld.org.

Media Contact: Gregory Bologna 
703/299-9766
[email protected] 
Press Room: November 10 – 13, 2011
Hynes Convention Center, Boston, MA
Telephone: 617-954-2624

Researcher: Edward W. Holt, MD
Email: [email protected]
Phone: 415-600-1020

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SOURCE American Association for the Study of Liver Diseases (AASLD)