Liver transplantation at the extremes of the body mass index

Abstract

Controversies exist regarding the morbidity and mortality of patients undergoing liver transplantation at the extremes of the body mass index (BMI ; severely obese, 35 to Ͻ40 kg/m 2 ; and very severely obese, Ն40 kg/m 2 . Survival rates were compared among these 6 categories via Kaplan-Meier survival curves with the log-rank test. The underweight and very severely obese groups had significantly lower survival. There were 1827 patients in the underweight group, 1447 patients in the very severely obese group, and 68,172 patients in the other groups, which became the control. Groups with extreme BMI (Ͻ18.5 and Ն40) were compared to the control to assess significant differences. Underweight patients were more likely to die from hemorrhagic complications (P Ͻ 0.002) and cerebrovascular accidents (P Ͻ 0.04). When compared with the control, the very severely obese patients had a higher number of infectious complications and cancer events (P ϭ 0.02) leading to death. In 3 different eras of liver transplantation, multivariable analysis showed that underweight and very severe obesity were significant predictors of death. In conclusion, liver transplantation holds increased risk for patients at the extremes of BMI. Identifying these patients and instituting aggressive new policies may improve outcomes. Liver Transpl 15:968-977, 2009.

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

“…4,5 Notably, the latter aspect could have been responsible of the difference between our findings and the results reported by previous meta-analyses as concerns the mortality risk. In fact, we found a pretty robust increase in OR at 30 days, when either BMI ≥30 and 40 were evaluated (1.90; CI: 1.38, R E F E R E N C E S 1 and prevention of relapse following surgery in Crohn's disease, 2 although its efficacy in the induction and maintenance of remission in Crohn's disease remains disputed.…”

“…3 In addition, the drug may be of benefit in a subset of patients with irritable bowel syndrome. 4,5 Diverticular disease is a chronic disorder of the lower GI tract.…”

Severe muscle depletion predicts postoperative length of stay but is not associated with survival after liver transplantation

“…Similarly to previous studies, we found that a low BMI was independently associated with mortality after liver transplantation. 20 We also found that only male patients with extreme sarcopenia (ie, those in the lowest L3 SMI sextile) had worse outcomes after liver transplantation; however, the presence of sarcopenia was associated with a longer recovery period after transplantation, which was reflected by the longer hospital stay needed because these patients required more inpatient rehabilitation. Also, similarly to previous studies, 4 we found that sarcopenia was associated with higher rates of bacterial infections, which were related to links between malnutrition and/or sarcopenia and impaired immunity.…”

Severe muscle depletion predicts postoperative length of stay but is not associated with survival after liver transplantation

“…We normally used nasogastric or nasoenteral feeding only for those patients with a body mass index less than 18.5 kg/m 2 because this has been shown to be a risk factor for mortality after liver transplantation, 4 but none of the patients in this cohort had a body mass index below this threshold.…”