Diabetes Mellitus, and Not Obesity, Is Associated with Lower Survival Following Liver Transplantation

Wong, Robert J.; Cheung, Ramsey; Perumpail, Ryan B.; Holt, Edward W.; Ahmed, Aijaz

doi:10.1007/s10620-014-3469-8

Cited by 41 publications

(39 citation statements)

References 40 publications

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“…To our knowledge, this is the first nationwide population-based study to investigate the effects of DM on the risk of post-LTx mortality and morbidity in an Asian population. Contrary to the previous publications [13][14][15][16], we observed that DM patients did not exhibit increased risks of early post-LTx morbidities or mortality compared with non-DM patients. However, further analysis showed that preexisting DM with renal manifestations was associated with a significantly higher mortality rate within 90 days after LTx, in comparison with the non-DM cohort.…”

Section: Discussioncontrasting

confidence: 99%

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Pre-existing diabetes and risks of morbidity and mortality after liver transplantation: A nationwide database study in an Asian population

Tsai

Wang

et al. 2015

European Journal of Internal Medicine

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Section: Discussioncontrasting

confidence: 99%

“…To date, some studies have evaluated the risk of perioperative mortality and complications after LTx in DM patients in a population-based setting [13][14][15][16]. However, there has been no similar study in an Asian population.…”

Section: Introductionmentioning

confidence: 99%

Pre-existing diabetes and risks of morbidity and mortality after liver transplantation: A nationwide database study in an Asian population

Tsai

Wang

et al. 2015

European Journal of Internal Medicine

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“…Such patients may be disproportionately affected by subclinical cardiac disease and a blunted cardiovascular response to the hemodynamic stress of LT resulting in arrhythmia and incident heart failure. Third, over the past decade there has been a marked rise in the prevalence of CVD comorbid conditions, such as diabetes, among LT candidates related to the ongoing obesity epidemic in the United States(8, 9). In fact, it is well established that nonalcoholic steatohepatitis (NASH), an obesity-related cause of end-stage liver disease that is associated with increased CVD morbidity and mortality(10, 11), is likely to become the most common indication for LT over the next decade(12, 13).…”

Section: Introductionmentioning

confidence: 99%

Factors Associated With Major Adverse Cardiovascular Events After Liver Transplantation Among a National Sample

VanWagner

Serper

Kang

et al. 2016

American Journal of Transplantation

150

161

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Assessment of major adverse cardiovascular events (MACE) after liver transplantation (LT) has been limited by the lack of a multi-center study with detailed clinical information. An integrated database linking information from the University HealthSystem Consortium and the OPTN was analyzed using multivariate Poisson regression to assess factors associated with 30- and 90-day MACE after LT (2/2002–12/2012). MACE were defined as myocardial infarction (MI), heart failure (HF), atrial fibrillation (AF), cardiac arrest, pulmonary embolism and/or stroke. Of 32,810 recipients, MACE hospitalizations occurred in 8% and 11% of patients at 30 and 90 days. Recipients with MACE were older, and more likely to have a history of NASH, alcoholic cirrhosis (ETOH), MI, HF, stroke, AF and pulmonary and chronic renal disease than those without MACE. In multivariable analysis, age > 65 (Incidence rate ratio (IRR)=2.8 (1.8–4.4)), ETOH (IRR=1.6 (1.2–2.2)), NASH (IRR=1.6 (1.1–2.4)), pre-LT creatinine (IRR=1.1 (1.04–1.2)), baseline AF (IRR=6.9 (5.0–9.6)) and stroke (IRR=6.3 (1.6–25.4)) were independently associated with MACE. MACE were associated with lower 1-year survival post-LT (79% vs. 88%, p<.0001). In a national database, MACE occurred in 11% of LT recipients with a negative impact on survival. Pre-LT AF and stroke substantially increase risk of MACE, highlighting potentially high-risk LT candidates.

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“…46 Up to 46% of patients will develop post-LT metabolic syndrome, with the greatest risk seen in those with BMI of 30 kg/m 2 or greater pre-LT. 43,44,46 Pretransplant obesity has been shown to be a strong risk factor for posttransplant weight gain 47,48 ). Even among 37 obese cirrhotic patients enrolled in an intensive pretransplant weight loss program (and who achieved target BMI <35 kg/m 2 ), 60% gained weight to a BMI greater than 35 kg/m 2 after LT. 18 Posttransplant obesity (class II or greater) increases the risk of posttransplant diabetes, a strong predictor of decreased survival after LT, 49,50 as well as post-LT nonalcoholic steatohepatitis. 47 The risk of new onset DM may be further heightened by corticosteroids and/or calcineurin-inhibitor use.…”

Section: Posttransplant Considerationsmentioning

confidence: 99%

Liver Transplantation in the Obese Cirrhotic Patient

Spengler

O’Leary

et al. 2017

Transplantation

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Despite the rapidly increasing prevalence of obesity in the transplant population, the optimal management of obese liver transplant candidates remains undefined. Setting strict body mass index cutoffs for transplant candidacy remains controversial, with limited data to guide this practice. Body mass index is an imperfect measure of surgical risk in this population, partly due to volume overload and variable visceral adiposity. Weight loss before transplantation may be beneficial, but it remains important to avoid protein calorie malnutrition and sarcopenia. Intensive lifestyle modifications appear to be successful in achieving weight loss, though the durability of these interventions is not known. Pretransplant and intraoperative bariatric surgeries have been performed, but large randomized controlled trials are lacking. Traditional cardiovascular comorbidities are more prevalent in obese individuals and remain the basis for pretransplant cardiovascular evaluation and risk stratification. The recent US liver transplant experience demonstrates comparable patient and graft survival between obese and nonobese liver transplant recipients, but obesity presents important medical and surgical challenges during and after transplant. Specifically, obesity is associated with an increased incidence of wound infections, wound dehiscence, biliary complications and overall infection, and confers a higher risk of posttransplant obesity and metabolic syndrome-related complications. In this review, we examine current practices in the obese liver transplant population, offer recommendations based on the currently available data, and highlight areas where additional research is needed.

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Diabetes Mellitus, and Not Obesity, Is Associated with Lower Survival Following Liver Transplantation

Abstract: In conclusion, obesity alone was not associated with lower post-transplant survival. However, DM, either alone or comorbid with obesity, is associated with significantly greater post-transplant mortality.

Cited by 41 publications

References 40 publications

Pre-existing diabetes and risks of morbidity and mortality after liver transplantation: A nationwide database study in an Asian population

Pre-existing diabetes and risks of morbidity and mortality after liver transplantation: A nationwide database study in an Asian population

Factors Associated With Major Adverse Cardiovascular Events After Liver Transplantation Among a National Sample

Liver Transplantation in the Obese Cirrhotic Patient

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