Increased morbidity in overweight and obese liver transplant recipients: A single-center experience of 1325 patients from the United Kingdom

Abstract

Obesity levels in the United Kingdom have risen over the years. Studies from the United States and elsewhere have reported variable outcomes for obese liver transplant recipients in terms of post-liver transplant morbidity, mortality, and graft survival. ). The primary outcome was an evaluation of graft and patient survival, and the secondary outcome was an assessment of postoperative morbidity. Bonferroni correction was applied with statistical significance set at P < 0.012. Kaplan-Meier curves were used to study the effects of BMI on graft and patient survival. A total of 1325 patients were included in the study: underweight (n 5 47 or 3.5%), normal-weight (n 5 643 or 48.5%), overweight (n 5 417 or 31.5%), obese (n 5 145 or 10.9%), and morbidly obese patients (n 5 73 or 5.5%). The rate of postoperative infective complications was significantly higher in the overweight (60.7%, P < 0.01) and obese recipients (65.5%, P < 0.01) versus the normal-weight recipients (50.4%). The morbidly obese patients had a longer mean intensive care unit (ICU) stay than the normal-weight patients (4.7 versus 3.2 days, P 5 0.03). The mean hospital stay was longer for the overweight (22.4 days, P < 0.001), obese (21.3 days, P 5 0.04), and morbidly obese recipients (22.4 days, P 5 0.047) versus the normal-weight recipients (18.0 days). There was no difference in death-censored graft survival or patient survival between the groups. In conclusion, this is the largest and only reported UK series on BMI and outcomes following liver transplantation. Overweight and obese patients have significantly increased morbidity in terms of infective complications after liver transplantation and, consequently, longer ICU and hospital stays.

Obesity and liver transplantation

“…Nair et al [22] analyzed the UNOS database on 18172 LT patients transplanted between 1988 and 1996 and found that primary graft dysfunction, perioperative mortality at 1, 2, and 5-years were significantly higher in the morbidly obese group due to cardiovascular adverse events. Similar outcomes were reported in 1325 obese LT recipients [27] from the United Kingdom where they had increased morbidity due to infectious complications, longer ICU and hospital stay in comparison to normal weight patients. However, other studies suggested that higher BMI should not be considered an absolute contraindication to LT [24,28] .…”

Is 40 the new 30?

“…However, studies have suggested higher morbidity in the early post-transplant setting and longer length of stay in patients that are morbidly obese [2,3]. This study by Singhal et al, supports these findings, but provides some granularity into why the postoperative complications may be more frequent and length of stay may be longer.…”

Liver Transplantation in the Obese Cirrhotic Patient

“…Alternatively, the obese patients may have had biliary complications that were less severe and more amenable to nonsurgical therapies. Although rates of postoperative respiratory infections were similar between the 2 groups, 38 postoperative respiratory failure occurred more commonly among obese versus nonobese recipients (23% vs 3%; P = 0.009). 32 …”

“…31,38,40,41 In the largest single-center cohort that included a total of 1325 LT recipients from 1994 to 2009, both ICU LOS (4.7 vs 3.2 days; P = 0.03) and total hospital LOS (22.4 vs 18.0 days; P = 0.047) were significantly higher among the 73 recipients with BMI of 35 or greater compared with the 643 recipients with BMI of 18.5 to 24.9. 38 These findings were confirmed in an analysis of the Scientific Registry of Transplant Recipients (SRTR) data. Among 12 445 LT recipients, 416 (3%) of whom had a BMI of 40 or greater (class III obesity) ICU days (mean [SD], 3 [6] vs 3 [4]; P < 0.001) and hospital days (11 [10] vs 9 [8]; P < 0.001) were both significantly higher in recipients with a BMI of 40 or greater compared with those with a BMI less than 40.…”