Weighing the risks: Morbid obesity and diabetes are associated with increased risk of death on the liver transplant waiting list

Kardashian, Ani; Dodge, Jennifer L.; Roberts, John P.; Brandman, Danielle

doi:10.1111/liv.13523

Cited by 43 publications

(48 citation statements)

References 31 publications

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“…Currently, NASH‐related cirrhosis is frequently missed as a diagnosis with the consequence of presenting with more advanced liver disease and HCC, thereby limiting potential curative options including transplantation . In addition, with the increasing prevalence of metabolic factors (diabetes, overweight, or obesity), which have a negative impact on wait‐list dropout rates and survival after LT, strategies to optimize weight and diabetes control and avoid sarcopenia should be prioritized in these patients within LT programs.…”

Section: Discussionmentioning

confidence: 99%

Increasing Incidence of Nonalcoholic Steatohepatitis as an Indication for Liver Transplantation in Australia and New Zealand

et al. 2019

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The worldwide increase in obesity and diabetes has led to predictions that nonalcoholic steatohepatitis (NASH) will become the leading indication for orthotopic liver transplantation (OLT). Data supporting this prediction from outside the United States are limited. Thus, we aimed to determine trends in the frequency of NASH among adults listed and undergoing OLT in Australia and New Zealand (ANZ) from 1994 to 2017. Data from the ANZ Liver Transplant Registry were analyzed with patients listed for fulminant liver failure, retransplantation, or multivisceral transplants excluded. Nonparametric trend, Spearman rank correlation, and regression analysis were used to assess trends in etiologies of liver disease over time. Of 5016 patient wait‐list registrants, a total of 3470 received an OLT. The percentage of patients with NASH activated for OLT increased significantly from 2.0% in 2003 to 10.9% in 2017 (trend analyses; P < 0.001). In 2017, NASH was the third leading cause of chronic liver disease (CLD) among wait‐list registrants behind chronic hepatitis C virus (HCV; 29.5%) and alcohol (16.1%). Similarly, significant increases over time in the percentage of patients undergoing OLT were observed for HCV and NASH (all trend analyses; P < 0.001) but with significant reductions in primary sclerosing cholangitis and cryptogenic cirrhosis (both P < 0.05). By 2017, NASH was the third leading cause of liver disease among patients undergoing OLT (12.4%) and behind chronic HCV (30.2%) and alcohol (18.2%). NASH also became the third most frequent etiology of CLD in patients transplanted (13.8%) with concomitant hepatocellular carcinoma by 2017. In conclusion, NASH is increasing as a primary etiology of liver disease requiring listing and liver transplantation in ANZ.

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Section: Discussionmentioning

confidence: 99%

Increasing Incidence of Nonalcoholic Steatohepatitis as an Indication for Liver Transplantation in Australia and New Zealand

et al. 2019

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“…(8,9) Class III obesity, in particular, has been found to be a risk factor for mortality among those awaiting liver transplantation (LT), according to two recent United Network for Organ Sharing (UNOS) registry studies. (10,11) In a recent study by Piano et al, several predictors of ACLF development were identified, including ascites, anemia, hypotension and increasing model for end-stage liver disease (MELD) score. (12) However, this study did not include obese patients, as the upper limit of body mass index (BMI) in their study population was 29 kg/m 2 .…”

Section: Introductionmentioning

confidence: 99%

Class III obesity is a risk factor for the development of acute-on-chronic liver failure in patients with decompensated cirrhosis

Sundaram

Jalan²,

Ahn

et al. 2018

Journal of Hepatology

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In this study, we identify that among patients with decompensated cirrhosis, class III obesity (severe/morbid obesity) is a modifiable risk factor for the development of acute-on-chronic liver failure (ACLF). We further demonstrate that regarding the specific organ failures associated with ACLF, renal failure is significantly more prevalent in obese patients, particularly those with class III obesity. These findings underscore the importance of weight management in cirrhosis, to reduce the risk of ACLF. Patients with class III obesity should be monitored closely for the development of renal failure.

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“…A similar observation has also been reported in a recent analysis for both LT alone and liver-kidney recipients. 25,26 While this study is not designed to provide rigorous evaluation of the reasons behind these outcome differences, they certainly merit further study.…”

Section: Characteristics Of Lt Recipients With Bashmentioning

confidence: 99%

Both Alcoholic and Nonalcoholic Steatohepatitis Is an Emerging Indication for Liver Transplantation in the United States

Fritze

Singh

Lawitz

et al. 2020

Digestive Disease Interventions

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Abstract Background Nonalcoholic steatohepatitis (NASH) and alcoholic liver disease (ALD) are now the most common indications for liver transplantation (LT) in the United States. A subset of patients have both alcoholic and nonalcoholic steatohepatitis (BASH). This study characterizes patients with BASH requiring LT and assesses changes in the prevalence of BASH as an indication for LT. Methods The United Network for Organ Sharing database was analyzed for all patients ≥ 18 years of age who received their first deceased donor LT from 2002 to 2016 for ALD, NASH, or BASH. Baseline demographics, clinical parameters, and LT outcomes were compared between groups. Results Since 2002, 85,448 patients underwent LT:15,327 had ALD, 9,971 had NASH, and 2,779 had BASH. The prevalence of BASH as an indication for LT increased from 0.5% in 2002 to 5% in 2016. Compared with patients with NASH, those with BASH were significantly more likely to be male (85.6 vs. 57%), younger (mean 56.4 vs. 58.6 years), and Hispanic (22.2 vs. 13.6%) (p < 0.001 for all). While indication for transplant was not significantly associated with transplant outcomes on multivariable analysis, patient and graft survival curves do differ significantly by indication for transplant, with worse outcomes for patients with BASH (patient survival at 5 years: NASH 78.1%, ALD 77.2%, BASH 73.5%, p = 0.013; graft survival at 5 years: NASH 75.3%, ALD 74.0%, BASH 70.8%, p = 0.046). Conclusions BASH is a rising indication for LT, especially for Hispanic males, due to the increasing prevalence of ALD and NASH in the United States.

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Weighing the risks: Morbid obesity and diabetes are associated with increased risk of death on the liver transplant waiting list

Abstract: Morbid obesity and diabetes are independent predictors of death in LT candidates.

Cited by 43 publications

References 31 publications

Increasing Incidence of Nonalcoholic Steatohepatitis as an Indication for Liver Transplantation in Australia and New Zealand

Increasing Incidence of Nonalcoholic Steatohepatitis as an Indication for Liver Transplantation in Australia and New Zealand

Class III obesity is a risk factor for the development of acute-on-chronic liver failure in patients with decompensated cirrhosis

Both Alcoholic and Nonalcoholic Steatohepatitis Is an Emerging Indication for Liver Transplantation in the United States

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