A multidisciplinary weight loss program incorporating GLP-1 receptor agonists helped most high-BMI liver transplant candidates lose enough weight to become eligible for surgery.
8 of 19 patients transplanted42% of high-BMI patients in the program achieved liver transplantation after a median weight loss of 11.7 kg
What the researchers found
Of 19 patients with high BMI referred to a multidisciplinary liver metabolic clinic, median weight loss was 11.7 kg (range 0–33 kg). Fifteen patients were treated with a GLP-1 receptor agonist (6 with liraglutide, 8 with semaglutide, 1 with tirzepatide) and 4 received phentermine. Eight patients (42%) ultimately received a liver transplant and 4 more were waitlisted. The median time from baseline to waitlisting was approximately 5.5 months (166 days). Eighty-four percent of patients had metabolic dysfunction-associated steatohepatitis as the underlying liver condition.
Why it matters
Patients with BMI over 40 are often considered ineligible for liver transplant, yet there is little guidance on how to help them lose enough weight to qualify. This study demonstrates that a structured, multidisciplinary program incorporating GLP-1 receptor agonists can help these critically ill patients achieve meaningful weight loss and gain access to life-saving transplantation.
The numbers in context
n=19 · median BMI 42 · median weight loss 11.7 kg · 84% had MASH · 8 patients transplanted · 4 more waitlisted · median 166 days to waitlisting · 15 treated with GLP-1 RA
How the study worked
Retrospective review of 19 patients aged 18 or older referred to the Henry Ford Health Liver Metabolic Clinic from August 2019 to September 2023 with BMI above 40 or above 35 with abdominal adiposity complicating surgery. Patients received individualized support from hepatologists, dieticians, and counselors, along with anti-obesity medications including GLP-1 receptor agonists or phentermine.
Who was studied
Adults with high BMI (median 42) and end-stage liver disease who were liver transplant candidates at a single U.S. center
What this study cannot tell us
This was a small, single-center retrospective study with only 19 patients and no control group, making it impossible to determine how much of the weight loss was attributable to the GLP-1 receptor agonists versus the dietary and counseling support. Four patients died during follow-up from progressive liver disease or infection, highlighting the fragility of this population.
How to read the evidence
This is a small, single-center retrospective case series with no control group. While the results are promising, the study design cannot establish causation or isolate the effect of GLP-1 receptor agonists from other program components.
When this study was published
Published in 2024, this study reflects current clinical practice with GLP-1 receptor agonists including semaglutide and tirzepatide, making its findings timely and relevant.
The bigger picture
GLP-1 receptor agonists are increasingly recognized for their dramatic weight loss effects, but their use in patients with severe liver disease has been largely unexplored. This study opens a new potential application for these peptide drugs — bridging critically ill patients to life-saving transplantation by reducing BMI below surgical risk thresholds.
Questions still open
- How do GLP-1 receptor agonists affect liver function and disease progression in patients with end-stage liver disease?
- Would a larger, controlled trial confirm that GLP-1 agonists offer advantages over other weight loss strategies in transplant candidates?
- What are the long-term post-transplant outcomes for patients who used GLP-1 receptor agonists to achieve transplant eligibility?
Common questions
Can GLP-1 receptor agonists be safely used in patients with severe liver disease?
How much weight did patients need to lose to qualify for a liver transplant?
Read the original research
Successful Implementation of a Multidisciplinary Weight Loss Program Including GLP1 Receptor Agonists for Liver Transplant Candidates With High Body Mass Index.
Transplantation, 108(11), 2233-2237
Citation
Gonzalez, Humberto C; Myers, Daniel T; Venkat, Deepak. (2024). Successful Implementation of a Multidisciplinary Weight Loss Program Including GLP1 Receptor Agonists for Liver Transplant Candidates With High Body Mass Index.. Transplantation, 108(11), 2233-2237. https://doi.org/10.1097/TP.0000000000005070