G Lassailly et al. Clin Gastroenterol Hepatol 2025; 23: 1567-1576. Open Access! Resolution of Metabolic Dysfunction-associated Steatohepatitis With No Worsening of Fibrosis After Bariatric Surgery Improves 15-year Survival: A Prospective Cohort Study

Methods: From 1994 to 2021, 3028 bariatric patients at the University Hospital of Lille were prospectively included. Baseline liver biopsies were systematically performed with proposed follow-up biopsies 1 year after surgery, mainly in patients with MASH. We evaluated the association of the baseline and 1-year histologic progression of MASH and fibrosis status and long-term survival. The median follow-up was 10.1 years. At baseline, 2641 patients (89%) had a biopsy, including 232 with MASH (8.7%) and 266 (10.8%) with significant fibrosis (grade F2-F4). At 1 year, 594 patients had qualitative paired biopsies.

Key findings:

• 15-year survival was shorter in patients with baseline MASH (83.9%) than in
  those without (92.7%)
• Similarly, the15-year survival rate was 79.8% in patients with significant fibrosis vs
  94.0% in patients without
• Compared with patients without baseline MASH, mortality increased in those with persistent MASH and/or if fibrosis worsened (adjusted HR 2.54), but not if MASH resolved without the worsening of fibrosis (adjusted HR, 0.73). This translates to a 15-year survival of 79.8% in patients with persistent MASH or worsening of fibrosis compared to 92.9% with patients without MASH and 88.4% in patients with a histologic resolution of MASH without the worsening of fibrosis (see below)

My take (borrowed in part from the authors): “This is the first study to show that the resolution of MASH with no worsening of fibrosis is associated with improved long-term survival.” Thus, histologic improvement is a very useful surrogate marker for long-term benefit in MASH, whether this is due to bariatric surgery as in this study but also with medical treatment.

Related blog posts:

• Fatty Liver Disease AASLD Practice Guidance 2023
• Mechanisms in Fatty Liver Disease Improved After Bariatric Surgery
• Key Insights on MASLD from Dr. Marialena Mouzaki
• Pharmacological Management of Pediatric Steatotic Liver Disease (2025)
• FDA Approves Semaglutide for MASH
• AASLD Practice Changes for Metabolic Liver Disease in 2024
• How Many Kids Would Be Good Candidates for Bariatric Surgery?
• Resmetirom (Rezdiffra) -FDA Approved for MASH with Moderate to Advanced Fibrosis
• You No Longer Have Fatty Liver Disease-You Have Steatotic Liver Disease!
• Resmetirom for MASH
• Tirzepatide for Metabolic Dysfunction–Associated Steatohepatitis (MASH) & Uptick in GLP1 Use
• Prevalence of Steatotic Liver Disease in U.S. And Risk of Complications
• Survodutide, Dual Glucagon Receptor/GLP-1 Receptor Agonist, for MASH (Phase II Trial)
• Non-Invasive Studies Often Fail to Detect Advanced Liver Fibrosis in Steatotic Liver Disease
• “You Can’t Outrun a Bad Diet”
• Pediatric Fatty Liver Disease is a Reversible Disease

Related News: Steve Gardner, USAToday 9/16/25: Legendary Dolphins QB Dan Marino reveals liver disease diagnosis

An excerpt:

In an interview with People magazine, the former Miami Dolphins quarterback said he first began feeling “a little fatigued” in 2007, and found out after a routine checkup that he had metabolic dysfunction-associated steatohepatitis, or MASH…

Marino, 64, says he now exercises more regularly than he did after his playing days ended. And he’s made major adjustments to his diet after doctors told him to “cut back on the wine and pizza and candy, ice cream, those kind of things.”