Editorial: liver transplantation in patients with non‐alcoholic fatty liver disease and obesity—authors’ reply

Abstract

2.62), and, at lesser extent, at 5 years only for patients with a BMI ≥40 (1.34; CI: 1.08, 1.67). Moreover, we found higher rates of postoperative and cardiopulmonary complications in those with a BMI ≥30 (OR=1.60; CI: 1.21, 2.11 and OR=2.62; CI: 1.35, 5.09, respectively).However, we agree that the study findings raise two main issues: comorbidities such as diabetes and hypertension, instead of obesity itself, could have been responsible for the worsening of early and longterm post-transplant outcomes. In this perspective, it would have been interesting to know the causes of long-term post-transplant mortality.Unfortunately, this information is rarely reported in the studies. The other argument to be debated is the concurrence of many other factors, in addition to obesity, which could influence post-operative outcomes, including donor related factors, a longer permanence on the waiting list of obese patients and/or the selection bias between programmes for various thresholds of obesity. 6,7 Also in this case, we were aware of this limitation as outlined in the discussion. However, an exact estimate of the influence of obesity on post-operative outcomes would require that all data from primary studies should be adjusted for the same factors contributing to aggravate patients' outcome, an intrinsic limitation of which the meta-analytic approach suffers. 8At the end of our commentary, we want to take the opportunity to reaffirm the concept that BMI has several limitations (it does not take into account body composition, which is influenced by gender and age, as well as the increase in extracellular fluids), and in the future, new and more precise anthropometric parameters such as muscle mass and visceral fat should be taken in consideration as post-transplant risk factors. ACKNOWLEDG EMENTSThe authors' declarations of personal and financial interests are unchanged from those in the original article.2 460 |

Systematic Assessment of Safety Threshold for Donor Age in Cadaveric Liver Transplantation

“…Finally, we wanted to emphasize that the exact estimation on the effect of comorbidities such as obesity and diabetes from donors on the relationship between donor age and post-transplant outcomes would require that all data from primary studies should be adjusted for the same factors. It's impossible for us to do it, because this is the intrinsic limitation of meta-analysis (57).…”