Impact of Morbid Obesity on Liver Transplant Candidacy and Outcomes: National and Regional Trends

Kaur, Navpreet; Emamaullee, Juliet; Lian, Tiffany; Lo, Mary; Ender, Philip B.; Kahn, Jeffrey; Sher, Linda

doi:10.1097/tp.0000000000003404

Cited by 14 publications

(4 citation statements)

References 34 publications

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“…12 Recent studies have shown that morbid obesity increases the likelihood of being delisted from the liver transplant waiting list. 13,14 Whether socioeconomic factors influence this finding should be investigated.…”

Section: Inequalities By Liver Diseasementioning

confidence: 99%

Applying an equity lens to liver health and research in Europe

Ventura‐Cots¹,

Bataller²,

Lazarus³

et al. 2022

Journal of Hepatology

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Section: Inequalities By Liver Diseasementioning

confidence: 99%

Applying an equity lens to liver health and research in Europe

Ventura‐Cots¹,

Bataller²,

Lazarus³

et al. 2022

Journal of Hepatology

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“…9 Other studies assert that obesity should be a contraindication for liver transplant, but the identification of a specific BMI cutoff remains elusive. [10][11][12] Still, others have concluded that BMI should not be used as a major predictor of outcomes, instead pointing to confounding characteristics such as NASH diagnosis. [13][14][15] Differences in outcome measures and statistical methods also contribute to controversy in the role of obesity in transplant decisions.…”

mentioning

confidence: 99%

Is Obesity Associated With Better Liver Transplant Outcomes? A Retrospective Study of Hospital Length of Stay and Mortality Following Liver Transplantation

Du¹,

Danforth²,

Waterman³

et al. 2022

Anesthesia &Amp; Analgesia

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BACKGROUND:The rise in obesity in the United States, along with improvements in antiviral therapies, has led to an increase in the number of obese patients receiving liver transplants. Currently, obesity is a relative contraindication for liver transplant, although exact body mass index (BMI) limits continue to be debated. Studies conflict regarding outcomes in obese patients, while some argue that BMI should not be used as an exclusion criterion at all. Therefore, this retrospective study-utilizing a large national database-seeks to elucidate the association between recipient BMI and hospital length of stay and mortality following liver transplant. METHODS: A retrospective study was conducted using the United Network for Organ Sharing Standard Transplant Analysis and Research database. Fine-Gray competing risk regressions were used to explore the association between BMI and rate of discharge, which varies inversely with length of stay. In our model, subdistribution hazard ratio (SHR) represented the relative change in discharge rate compared to normal BMI, with in-hospital death was considered as a competing event for live discharge. Cox proportional hazard models were built to assess the association of BMI category on all-cause mortality after liver transplantation. Cluster-robust standard errors were used in all analyses to construct confidence intervals. RESULTS: Within the final sample (n = 47,038), overweight (≥25 and <30 kg/m 2 ) patients comprised the largest BMI group (34.7%). The competing risk regression model showed an association for increased length of stay among underweight (SHR = 0.82, 95% confidence interval [CI], 0.77-0.89; P < .001) and class 3 obesity patients (SHR = 0.88, 95% CI, 0.83-0.94; P < .001), while overweight (SHR = 1.05, 95% CI, 1.03-1.08; P < .001) and class 1 obesity (SHR = 1.04, 95% CI, 1.01-1.07; P = .01) were associated with decreased length of stay. When the sample excluded patients with low pretransplant functional status, however, length of stay was not significantly shorter for overweight and obesity class 1 patients. Cox proportional hazard models demonstrated increased survival among overweight, class 1 and class 2 obesity patients and decreased survival among underweight patients. CONCLUSIONS: Our results provide evidence that overweight and obesity class 1 are associated with decreased length of stay and mortality following liver transplant, while underweight and obesity class 3 are associated with prolonged length of stay. Pretransplant functional status may contribute to outcomes for overweight and class 1 obese patients, which necessitates continued investigation of the isolated impact of BMI in those who have had a liver transplant. (Anesth Analg 2022;135:118-27) KEY POINTS• Question: Is recipient obesity before liver transplant associated with prolonged hospital length of stay or increased mortality? • Findings: Overweight and obesity class 1 are associated with decreased length of stay and longterm mortality, while obesity class 3 and underweight are associate...

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“…Those with elevated BMI and moderate ascites may bene t from weight maintenance, in contrast to aggressive weight loss therapy, if there is an impending LT. Nonetheless, this is a case-by-case decision, as severe forms of obesity (morbid obesity) may cause harm and render the LT process to be surgically di cult (37)(38)(39). Conversely, patients with underweight or normal BMI in the setting of ascites would likely bene t from aggressive nutritional and exercise plans to increase weight and muscle mass.…”

Section: Discussionmentioning

confidence: 99%

The causes of death in patients with nonalcoholic steatohepatitis following liver transplantation stratified using pre-liver transplant BMI

et al. 2023

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Background & Aims:Determining the effects of pre-liver transplant (LT) BMI independent of underlying ascites on the post-LT outcomes of patients with nonalcoholic steatohepatitis (NASH) is needed to clarify the paradoxical and protective effects of obesity on post-LT endpoints. In order to accomplish this, we used graded severities of ascites to stratify the NASH-LT population and to perform an ascites-speci c strata analysis with differing pre-LT BMI levels. Methods 2005-2019 United Network for Organ Sharing (UNOS) Standard Transplant Analysis and Research (STAR) database was queried to select patients with NASH, who were categorized into speci c sets of ascites severity: no ascites (n = 1713), mild ascites (n = 5658), and moderate ascites (n = 4214). Then, BMI classi cation (underweight: <18.5, normal: 18.5-25, overweight: 25-30, obese: ≥30 kg/m²) was used to stratify each ascites-speci c group and to compare to the post-LT mortality endpoints. Those under 18 years old and those who received living/multi-organ transplants were excluded. ResultsAmong each ascites category, there were the following numbers of normal, underweight, overweight, and

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Impact of Morbid Obesity on Liver Transplant Candidacy and Outcomes: National and Regional Trends

Cited by 14 publications

References 34 publications

Applying an equity lens to liver health and research in Europe

Applying an equity lens to liver health and research in Europe

Is Obesity Associated With Better Liver Transplant Outcomes? A Retrospective Study of Hospital Length of Stay and Mortality Following Liver Transplantation

The causes of death in patients with nonalcoholic steatohepatitis following liver transplantation stratified using pre-liver transplant BMI

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