Office-Based Weight Loss Counseling Is Ineffective in Liver Transplant Recipients

Patel, Samarth; Siddiqui, Mohammad; Chadrakumaran, Anchalia; Faridnia, Masoud; Lin, Fei‐Pi; Román, José Hernández; Carbone, Salvatore; Laurenzo, John; Clinton, Joseph; Kirkman, Danielle L.; Wolver, Susan; Celi, Francesco S.; Bhati, Chandra

doi:10.1007/s10620-019-05800-6

Cited by 12 publications

(11 citation statements)

References 42 publications

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“…[23] Indeed, previous experience shows that standard office-based weight-loss counseling is ineffective in this population. [24] Finally, a role of immunosuppression cannot be discarded as using everolimus has also been associated with lower post-LT weight gain. [25] Indeed, the contribution of immunosuppression to our results is clear considering the different CV profiles of immunosuppressants.…”

Section: Discussionmentioning

confidence: 99%

Results of a multidisciplinary strategy to improve the management of cardiovascular risk factors after liver transplantation

et al. 2022

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Although liver transplantation (LT) recipients are at high cardiovascular risk (CVR), the management of CVR factors (CVRF) after LT is far from optimal and needs to be improved. For this reason, we developed a multidisciplinary protocol to standardize the identification, risk stratification, management, and targets of therapy of CVRF during the first post-LT year. The grade of identification and control of CVRF 12 months after LT in the postintervention cohort

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Section: Discussionmentioning

confidence: 99%

Results of a multidisciplinary strategy to improve the management of cardiovascular risk factors after liver transplantation

et al. 2022

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“…30 The increased incidence of posttransplant diabetes mellitus is associated with a worse outcome of LT. 31 Currently, our institution manages post-LT obese patients with active weight-loss programs, including standard lifestyle advice, dietary modification, and physical therapy; however, emerging evidence showed that office-based lifestyle intervention was ineffective in achieving weight loss in LT recipients. 32 Thus, even our study showed the long-term graft and patient survival of the class III obesity group was comparable with other groups, we should consider more aggressive post-LT intervention to prevent long-term BMI increase for the class III obesity group. This study has several limitations.…”

Section: Discussionmentioning

confidence: 56%

Liver Transplantation in Recipients With Class III Obesity: Posttransplant Outcomes and Weight Gain

Soma

Park

Mihaylov

et al. 2022

Transplantation Direct

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Background. There has been a dramatic increase in obesity in the United States. Several studies have reported conflicting results for the impact of obesity on outcomes of liver transplantation (LT). This study aims to assess the impact of obesity on LT and changes in body mass index (BMI) after transplantation. Methods. All adult LTs performed at Indiana University between 2001 and 2018 were reviewed. BMIs of recipients were subdivided into 6 categories. Survival outcomes were compared across the subgroup. BMI was followed up in a cohort of patients from 2008 to 2018. Results. Among 2024 patients, 25% were in class I obesity, 9.3% were in class II obesity, and 1.1% were in class III obesity. There was no significant difference in patient and graft survival at 10-y follow-up with respect to BMI. Among 1004 patients in the subgroup, BMI of all groups except the underweight group declined in the first 3 mo postoperatively; however, the BMI of all groups except the class III obesity group returned to the pre-LT level by 2 y and reached a plateau by 5 y. In the class III obesity group, there was a significant increase in body weight at 5 y. Conclusions. Class III obesity was not associated with higher mortality in our cohort. Because our cohort is small, it may be underpowered to detect a smaller difference in outcome. From our observation, obesity should not be considered a contraindication for LT. Post-LT interventions are required to prevent significant weight gain for the class III obesity group.

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“…However, emerging evidence showed that o ce-based lifestyle intervention was ineffective in achieving weight loss in LT recipients. 33 Thus, even our study showed the long-term graft and patient survival of the class obesity group was comparable with other groups, we should consider more aggressive post LT intervention to prevent long-term BMI increase for the class obesity group. This study has several limitations.…”

Section: Discussionmentioning

confidence: 57%

Liver transplantation in recipients with class III obesity: post-transplant outcomes and weight gain

Soma

Park

Mihaylov

et al. 2020

Preprint

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Background Over the past decades, there has been a dramatic increase in obesity in the United States. Several studies have reported conflicting results for the impact of obesity on outcomes of liver transplantation (LT). This study aims to assess severe obesity's impact on LT outcomes and changes in body mass index (BMI) after transplantation.Methods All adult LT performed at Indiana University Health University Hospital between July 2001 and December 2018 were reviewed. A retrospective analysis for identified 2024 patients was conducted. BMI of recipients is subdivided into underweight, normal, overweight, class Ⅰ obesity, class Ⅱ obesity, and class Ⅲ obesity (<18.5; 18.5-24.9; 25‐29.9; 30‐34.9; 35‐39.9; ≥40 kg/m2, respectively). Survival outcomes were compared between each group. Post-transplant BMI was followed up in a sub-group of patients receiving LT from January 2008 to December 2018. A retrospective analysis for identified 1004 patients was conducted.Results Among 2024 patients in the analytic cohort, 1.9% were underweight, 24.5% were normal, 32.6% were overweight, 25% were in class Ⅰ obesity, 9.3% were in class Ⅱ obesity, and 1.1% were in class Ⅲ obesity. There was no significant difference in patient and graft survival at 10-year follow-up with respect to recipient obesity. The 1, 3, 5, and 10-year graft and patient survivals in class Ⅲ obesity group were 97.0%, 92.1%, 87.0%, and 79.8% for patient survival and 94.4%, 85.1%, 79.8%, and 72.5% for graft survival. Among 1004 patients identified in the sub-group, BMI of all groups except the underweight group declined in the first three months postoperatively. After the three months, the BMI of all groups except the class Ⅲ obesity group returned to the pre LT level by two years and reached a plateau by five years. In patients with class Ⅲ obesity, there was a significant increase in body weight after long-term follow-up.Conclusion In this study, class Ⅲ obesity is not associated with higher mortality. Obesity, including class Ⅲ obesity, should not be considered a contraindication to LT in the absence of other contraindications. Post-LT interventions are required to prevent significant weight gain in recipients with class Ⅲ obesity after transplantation.

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Office-Based Weight Loss Counseling Is Ineffective in Liver Transplant Recipients

Cited by 12 publications

References 42 publications

Results of a multidisciplinary strategy to improve the management of cardiovascular risk factors after liver transplantation

Results of a multidisciplinary strategy to improve the management of cardiovascular risk factors after liver transplantation

Liver Transplantation in Recipients With Class III Obesity: Posttransplant Outcomes and Weight Gain

Liver transplantation in recipients with class III obesity: post-transplant outcomes and weight gain

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