Pharmacological treatment of obesity in liver transplant candidates: initial experience

Czech version

Authors: R. Lukáčik ¹ ; A. Němcová ² ; P. Taimr ¹ ; H. Gottfriedová ¹ ; Pavel Trunečka ¹ ; M. Haluzík ² ; Tomáš Hucl ¹ ; Irena Míková ¹
Authors‘ workplace: Klinika hepatogastroenterologie, IKEM, Praha ¹; Centrum diabetologie, IKEM, Praha ²
Published in: Gastroent Hepatol 2026; 80(4): 308-313
Category: Clinical and Experimental Gastroenterology: Original Article
doi: https://doi.org/10.48095/ccgh2026308

Overview

Introduction and aims: Obesity is an increasing clinical problem among liver transplant (LT) candidates and is associated with worse patient and graft survival and a higher risk of complications. Clinical experience with pharmacological treatment of obesity using incretin--based anti-obesity agents in LT candidates remains very limited. The aim of our study was to evaluate the effect of pharmacological treatment of obesity in 3 LT candidates on changes in body weight, liver function, liver disease-related complications, and treatment tolerance. Methods: This retrospective analysis included LT candidates with class III obesity in whom pharmacotherapy of obesity using incretin-based anti-obesity agents was initiated in 2025. Results: We evaluated the course of treatment for obesity in three female LT candidates (aged 54–55 years) with class III obesity (BMI 43.4–44.5 kg/m²) and liver cirrhosis (Child-Pugh B–C, MELD-Na 17–20). Patients were treated with semaglutide, liraglutide, or tirzepatide for 6–12 months. Treatment led to a reduction in total body weight (TBWL) of 20.2%, 7.5%, and 6.2%. The change in MELD-Na score during treatment was −2, −3, and +4. Two patients showed improvement in liver function, leading to postponement of waitlisting; the third patient was listed and underwent LT, with a complicated post-transplant course. Treatment was well tolerated in all patients with no serious adverse events. Conclusion: Pharmacological treatment of obesity with incretin-based anti-obesity agents is feasible in selected stable LT candidates; however, attention must be paid to the risk of sarcopenia. The benefits and safety of this treatment in LT candidates should be confirmed in a prospective randomized trial.

Keywords:

liver transplantation – obesity – incretin-based anti-obesity agents – semaglutide – liraglutide – tirzepatide – liver cirrhosis – sarcopenia

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