{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T15:54:07Z","timestamp":1786982047439,"version":"build-2736575974"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2025,4,12]],"date-time":"2025-04-12T00:00:00Z","timestamp":1744416000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,4,12]],"date-time":"2025-04-12T00:00:00Z","timestamp":1744416000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100007687","name":"Svenska L\u00e4kares\u00e4llskapet","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100007687","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004359","name":"Vetenskapsr\u00e5det","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004047","name":"Karolinska Institute","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004047","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["OBES SURG"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Metabolic dysfunction-associated steatotic liver disease can progress to end-stage liver disease. Whether bariatric surgery influences this risk is uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This population-based cohort study included all patients with an obesity diagnosis between 1989 and 2020 according to the nationwide patient registries in Denmark, Finland, Norway, and Sweden. Bariatric surgery was compared with non-operative care for incidence and mortality in end-stage liver disease. Patients with a history of alcohol overconsumption or liver disease at baseline were excluded. Multivariable Cox regression provided hazard ratios (HR) with 95% confidence intervals (CI), adjusted for sex, calendar year, diabetes, Charlson comorbidity index, and country.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 654,409 participants with obesity, 86,356 (12.6%) underwent bariatric surgery. During a follow-up period of up to 31 years (median 7.3 years), bariatric surgery was followed by increased incidence (HR 1.23, 95% CI 1.11\u20131.37) and mortality (HR 1.93, 95% CI 1.56\u20132.38) in end-stage liver disease compared to non-operative care. The incidence decreased between 1 and 5\u00a0years after bariatric surgery but thereafter increased. Censoring patients who developed specific liver diseases (not steatotic liver disease) or alcohol overconsumption during follow-up canceled the association (HR 0.92, 95% CI 0.70\u20131.06). The mortality in end-stage liver disease was similar after bariatric surgery compared to non-operative care within 1\u20135 years of follow-up, but thereafter more than twofold increased. Analyses restricted to gastric bypass showed similar associations regarding both incidence (HR 1.26, 95% CI 1.11\u20131.43) and mortality (HR 2.20, 95% CI 1.72\u20132.82) of end-stage liver disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Bariatric surgery might be followed by an increased risk of end-stage liver disease.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11695-025-07857-x","type":"journal-article","created":{"date-parts":[[2025,4,12]],"date-time":"2025-04-12T07:23:11Z","timestamp":1744442591000},"page":"1845-1853","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Bariatric Surgery and Risk of End-Stage Liver Disease in a Four-Country Cohort Study"],"prefix":"10.1007","volume":"35","author":[{"given":"Dag","family":"Holmberg","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giola","family":"Santoni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"My","family":"von Euler-Chelpin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joonas H.","family":"Kauppila","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eivind","family":"Ness-Jensen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesper","family":"Lagergren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,4,12]]},"reference":[{"key":"7857_CR1","doi-asserted-by":"publisher","first-page":"2212","DOI":"10.1016\/S0140-6736(20)32511-3","volume":"397","author":"EE Powell","year":"2021","unstructured":"Powell EE, Wong VW, Rinella M. 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