Effect of body mass index on the survival benefit of liver transplantation

Pelletier, Shawn J.; Schaubel, Douglas E.; Wei, Guanghui; Englesbe, Michael J.; Punch, Jeffrey D.; Wolfe, Robert A.; Port, Friedrich K.; Merion, Robert M.

doi:10.1002/lt.21183

Cited by 117 publications

(121 citation statements)

References 18 publications

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“…6 The study reported in this issue of Liver Transplantation by Pelletier et al 7 shows that the prevalence of obesity has increased significantly in more recent years. Of those who underwent transplantation between 2001 and 2004, 32.5% were obese, and among them, 8.4% were severely obese and 3.2% were morbidly obese.…”

Section: See Article On Page 1678mentioning

confidence: 98%

“…In both renal and liver transplant recipients, cardiovascular complications were the main cause of increased mortality. 6,9 Pelletier et al 7 examine survival benefits of liver transplantation according to recipient BMI. Using the Scientific Registry of Transplant Recipients database from September 2001 to December 2004, the authors report that transplant recipients, when compared to those who were listed and did not undergo transplantation, had survival benefits irrespective of their BMI.…”

Section: See Article On Page 1678mentioning

confidence: 99%

“…[1][2][3]5 Collective outcome data from liver and renal transplantation also indicate that morbidly obese patients have an increased morbidity and mortality compared to less obese patients. [6][7][8][9][10][11][12][13][14][16][17][18][19][20] These cumulative data mandate that morbidly obese patients be carefully evaluated for other serious comorbid illnesses before listing. Once listed, they should undergo careful surveillance and health maintenance programs to improve the outcomes.…”

Section: See Article On Page 1678mentioning

confidence: 99%

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Morbid obesity with one or more other serious comorbidities should be a contraindication for liver transplantation

Thuluvath

2007

Liver Transpl

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The prevalence of obesity is increasing in the United States and the rest of the world. The World Health Organization reported last year that over a billion people in the world are obese, surpassing 600 million malnourished people. In some ways, this is a reassuring sign that we are combating poverty in the world, but the impact of obesity on long-term morbidity, mortality, and utilization of health resources is similar or higher. [1][2][3][4][5] The reports from the Centers for Disease Control and the National Health and Nutrition Examination Surveys suggest that Ͼ20% of the U.S. population is obese as defined by a body mass index (BMI) Ͼ30 kg/ m 2 . Whereas infections are the most common causes of death in the malnourished, degenerative and vascular diseases are the common causes of death in obese people. [1][2][3][4][5] The Centers for Disease Control estimates that approximately 100 billion dollars are spent every year in the United States on obesity-related type 2 diabetes mellitus and 22 billion on obesity-related osteoarthritis.The United Network for Organ Sharing database from 1988 to 1996 showed that 16.8% of liver transplant recipients had BMI Ն30 kg/m 2 and of these 5.3% were severely obese (BMI Ն35 kg/m 2 ) and 2.1% were morbidly obese (BMI Ն40 kg/m 2 ). 6 The study reported in this issue of Liver Transplantation by Pelletier et al. 7 shows that the prevalence of obesity has increased significantly in more recent years. Of those who underwent transplantation between 2001 and 2004, 32.5% were obese, and among them, 8.4% were severely obese and 3.2% were morbidly obese. Within a decade, it appears that the prevalence of obesity (BMI Ն30 kg/m 2 ) has increased by 93% among liver transplant recipients, and moreover, there was 58% increase in severe obesity and 52% increase in morbid obesity. This increase is mostly a reflection of the changes in the general population. Fluid overload and inactivity, probably related to the advanced liver disease, may have contributed to the increased prevalence of obesity in this population, but it is difficult to assume that these factors have changed in the past decade. 4 Nevertheless, these data indicate that we need to continue to monitor the outcomes of obese patients on a continuous basis as the epidemiology is rapidly shifting in the wrong direction.The impact of obesity on renal transplantation has been studied more extensively than liver transplantation. 8,9 An analysis of 51,927 renal transplant recipients showed that extremes of BMI (Ͻ18 and Ͼ36) were associated with worse graft and patient survival. 8 In addition, higher BMI was associated with delayed graft function and chronic graft failure. Registry data (from 1987 to 2002) on 6,658 children aged 2 to 17 yr who received renal transplantation showed that BMI Ͼ95 percentile (9.7% of the study population) for age was associated with a higher risk of death (relative risk 2.9 for cadaver and 3.7 for living donor) and graft loss (19% vs. 10% for nonobese) due to thrombosis. 10 Obesity has also been described a...

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Section: See Article On Page 1678mentioning

confidence: 98%

Section: See Article On Page 1678mentioning

confidence: 99%

Section: See Article On Page 1678mentioning

confidence: 99%

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Morbid obesity with one or more other serious comorbidities should be a contraindication for liver transplantation

Thuluvath

2007

Liver Transpl

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“…IMPLICATIONS OF OVERWEIGHT IMPLICATIONS OF OVERWEIGHT IMPLICATIONS OF OVERWEIGHT IMPLICATIONS OF OVERWEIGHT IMPLICATIONS OF OVERWEIGHT AND OBESITY IN LIVER AND OBESITY IN LIVER AND OBESITY IN LIVER AND OBESITY IN LIVER AND OBESITY IN LIVER TRANSPLANTATION TRANSPLANTATION TRANSPLANTATION TRANSPLANTATION TRANSPLANTATION There are several implications of obesity in patients undergoing liver transplantation. Studies have shown that the obesity of donor and recipient may influence operative results [36][37][38][39][40][41][42] . Pre-obese patients are more likely, to develop primary graft dysfunction, delayed graft function after the operation and have increased risk of death 36,37 .…”

Section: Introduction Introduction Introduction Introduction Introducmentioning

confidence: 99%

“…Studies have shown that the obesity of donor and recipient may influence operative results [36][37][38][39][40][41][42] . Pre-obese patients are more likely, to develop primary graft dysfunction, delayed graft function after the operation and have increased risk of death 36,37 . These findings have not been universal, however, 38 .…”

Section: Introduction Introduction Introduction Introduction Introducmentioning

confidence: 99%

Excesso de peso em pacientes submetidos ao transplante hepático

Anastácio

Angelis-Pereira

Vilela

et al. 2013

Rev. Col. Bras. Cir.

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ABSTRACT ABSTRACT ABSTRACTThis review aims to describe the incidence and prevalence of overweight and obesity after liver transplantation and the consequences associated with it. Literature review consultation was conducted in Medline / PubMed, SciELO, EMBASE and LILACS, with the combination of the following keywords: liver transplantation, overweight, obesity, weight gain. Overweight is incident on more than 60% of patients undergoing liver transplantation and obesity rates exceed 20% in the first year after surgery, during which occurs the largest relative weight gain. Studies have shown that between 60% and 70% of patients undergoing liver transplantation are overweight after the third year, 90% with abdominal obesity. Associated factors are, among others, advanced age, family history of overweight and excess weight prior to liver disease. The contribution of immunosuppressive medication remains controversial. Some of the consequences of overweight are liver steatosis, steatohepatitis, diabetes mellitus, hypertension, dyslipidemia, cardiovascular disease and death.

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