Peverelle M, Ng J, Peverelle J, Hirsch RD, Testro A. Liver decompensation after rapid weight loss from semaglutide in a patient with non-alcoholic steatohepatitis -associated cirrhosis. World J Gastroenterol 2023; 29(47): 6165-6167 [PMID: 38186682 DOI: 10.3748/wjg.v29.i47.6165]
Corresponding Author of This Article
Matthew Peverelle, MD, Doctor, Liver transplant unit, Austin Health, 145 Studley Rd, Heidelberg VIC 3084, Melbourne 3084, Australia. matthewpeverelle@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Letter to the Editor
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Dec 21, 2023; 29(47): 6165-6167 Published online Dec 21, 2023. doi: 10.3748/wjg.v29.i47.6165
Liver decompensation after rapid weight loss from semaglutide in a patient with non-alcoholic steatohepatitis -associated cirrhosis
Matthew Peverelle, Jonathan Ng, James Peverelle, Ryan D. Hirsch, Adam Testro
Matthew Peverelle, Jonathan Ng, James Peverelle, Ryan D. Hirsch, Liver transplant unit, Austin Health, Melbourne 3084, Australia
Adam Testro, Liver transplant unit, Austin Health, Heidelberg 3084, Victoria, Australia
Author contributions: Peverelle M, Ng J and Peverelle J designed research and collected data; Hirsch RD analyzed data and designed figures; Testro A analyzed and interpreted data; All authors contributed to the drafting of the manuscript and all authors have given final approval for its submission.
Conflict-of-interest statement: Dr. Peverelle has nothing to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Received: October 17, 2023 Peer-review started: October 17, 2023 First decision: October 31, 2023 Revised: November 10, 2023 Accepted: December 2, 2023 Article in press: December 2, 2023 Published online: December 21, 2023
Abstract
There is rapidly increasing uptake of GLP-1 (glucagon-like peptide-1) agonists such as semaglutide worldwide for weight loss and management of non-alcoholic steatohepatitis (NASH). remains a paucity of safety data in the vulnerable NASH cirrhotic population. We report herein the first documented case of liver decompensation and need for liver transplant waitlisting in a patient with NASH-cirrhosis treated with semaglutide. Rapid weight loss led to the development of ascites and hepatic encephalopathy and an increase in the patients Model for Endstage Liver Disease-Na (MELD-Na) score from 11 to 22. Aggressive nutritional supplementation was commenced and the semaglutide was stopped. Over the following months she regained her weight and her liver recompensated and her MELD-Na decreased to 13, allowing her to be delisted from the transplant waitlist. This case serves as a cautionary tale to clinicians using semaglutide in the cirrhotic population and highlights the need for more safety data in this patient group.
Core Tip: Patients with NASH cirrhosis who lose weight rapidly with semaglutide are at risk of liver decompensation. This complication requires the immediate cessation of semaglutide and aggressive nutritional rehabilitation with supplemental protein feeds and micronutrients. Restoration of lost weight can lead to liver recompensation; however, consideration of liver transplantation should be given to patients who fail to respond to treatment.
