Bariatric surgery may increase risk for acetaminophen related liver injury

BOSTON – Patients who undergo bariatric surgery may be more likely to develop acetaminophen-related liver injury, according to a study presented at The Liver Meeting 2012.

Researchers evaluated 101 patients with acute liver failure, including 54 with acetaminophen (APAP)-induced liver failure (APAP-ALF). Prevalence of prior bariatric surgery (BS) in patients with APAP-ALF was recorded and compared to that of the general population and of non-APAP-ALF patients.

“Previous reports suggest that, following bariatric surgery, higher peak serum concentrations of ethanol after a challenge, and a higher rate of suicide compared to matched controls are observed,” the researchers wrote. “We hypothesized that prior BS might also predispose patients to an increased risk of APAP-related liver injury.”

Patients with APAP-ALF had previously undergone BS in 16.7% of cases, including eight Roux-en-Y procedures and one duodenal switch, with a mean of 5.9 years between the procedure and presentation with liver failure. No participants with non-APAP-ALF had undergone BS (P=.003 for difference). The prevalence of BS between patients with APAP-ALF and the general population was approximately 30 times that of the general population (16.7% vs. 0.5%, P=.0001).

Unlike data reported in prior studies, investigators noted that patients with APAP-ALF who had previously undergone BS had fewer incidences of depression or alcohol abuse compared with those with APAP-ALF who had not (P=.04 for depression and .03 for alcohol abuse), and also were not significantly more likely to intend self-harm (22.2% of BS recipients compared with 35.6%, P=.4). Other factors such as age, sex or the incidence of liver transplantation were not significantly different.

“To the best of our knowledge, this is the first report of bariatric surgery in acetaminophen-induced ALF,” researcher Edward W. Holt, MD, Department of Transplantation, Hepatology Division of California Pacific Medical Center in San Francisco, said in a press release. “… 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. … We would like to 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 BS.”

For more information:

Holt EW. #4: Prior Bariatric Surgery Increases the Risk of Acute Liver Failure from Acetaminophen Poisoning. Presented at: The Liver Meeting 2012; Nov. 9-13, Boston.

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