Comparable graft and patient survival in lean and obese liver transplant recipients

Abstract

Obesity is among the great health problems facing Americans today. More than 32% of the US population is considered obese on the basis of a body mass index (BMI) exceeding 30 kg/m 2 . Obesity increases the risk for numerous perioperative complications, but how obesity affects the outcome of liver transplantation remains unclear. We compared graft/patient survival after orthotopic liver transplantation performed at the Cleveland Clinic between April 2005 and June 2011 in 2 groups: obese patients with a BMI 38 kg/m 2 and lean patients with a BMI between 20 and 26 kg/m 2 . We included 47 obese patients and 183 lean patients, whose demographics and baseline characteristics were well balanced after weighting with the inverse propensity score. After we controlled for observed confounding, no significant differences were observed in graft/patient survival between obese and lean patients (P 5 0.30). The estimated hazard ratio for obese patients to experience graft failure or death was 1.19 [95% confidence interval (CI) 5 0.85-1.67]. There were 134 patients who had follow-up for more than 3 years, and they included 27 obese patients and 107 lean patients. Within this subset, the odds of having metabolic syndrome were significantly greater for obese patients (46%) versus lean patients (21%; odds ratio 5 4.76, 99.5% CI 5 1.66-13.7, P < 0.001). However, no significant association between obesity and any other long-term adverse outcomes was found. In conclusion, this study shows that transplant outcomes were comparable for lean and obese recipients. We thus recommend that even morbid obesity per se should not exclude patients from consideration for transplantation. Liver

Nonalcoholic fatty liver disease and bariatric surgery: a comprehensive review

“…This surgery may be performed before, after or even during the transplantation. 171 One significant concern is the potential impact of obesity on the outcomes from liver transplantation. Recently, it was observed that surgical mortality, two-year survival and graft viability were similar in obese and lean individuals.…”

Bariatric surgery in individuals with liver cirrhosis: A narrative review

“…Perioperative morbidity is slightly higher. 2,3 Performing bariatric surgery in non--compensated transplant candidates leads to higher morbidity and mortality, including the occurrence of anastomotic fistulas, which often reaches 12.5%. 21,22 Recently, there has been growing interest in the possibility of endoluminal treatments for obesity in individuals with high surgical risk.…”

“…1 Likewise, the prevalence of obesity among cirrhotic individuals who are candidates for liver transplantation has almost doubled since the 1990s, reaching more than 30%. 2,3 Furthermore, obesity and metabolic syndrome have presented an increasingly significant causal relationship with chronic liver disease. 4 Non-alcoholic fatty liver disease (NAFLD) is currently the third leading cause of liver transplantation in the United States of America (USA).…”

Liver Transplantation for Nonalcoholic Fatty Liver Disease: Role of Bariatric Surgery for Comorbid Obesity

“…Studies evaluating United Network for Organ Sharing/Organ Procurement and Transplantation Network (UNOS/OPTN) and United Kingdom Transplant data similarly report worse outcomes in obese patients, notably due to increased graft dysfunction, frequency of cardiovascular events, infectious complications, and longer hospital stays [11,12] . However, conflicting data from Perez-Protto noted no significant differences in perioperative morbidity and mortality in lean (BMI 20-26 kg/m 2 ) versus obese (BMI>38 kg/m 2 ) liver transplant recipients [13] . Nevertheless, given the evidence regarding the negative impact of comorbid obesity, liver transplant providers routinely attempt to address this disease with standard of care approaches including dietary counseling, exercise programs, and behavioral therapies during transplant evaluation and waitlist management.…”