Obesity does not significantly impact outcomes following simultaneous liver kidney transplantation: review of the UNOS database - a retrospective study

Yu, Jonathan W; Gupta, Gaurav; Kang, Le; Bandyopadhyay, Dipankar; Siddiqui, M. Shadab; Bhati, Chandra; Stravitz, R. Todd; Levy, Marlon F.; Reichman, Trevor

doi:10.1111/tri.13352

Cited by 15 publications

(11 citation statements)

References 37 publications

(43 reference statements)

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“…Obesity is also associated with increased incidence of recurrence of HCC for patients with HCC undergoing LT (19). Contrary to most data identifying obesity as a risk factor for graft survival, a retrospective study of UNOS database showed that BMI is not a risk factors for poor patient and both liver and kidney graft survival (20). This study analyzed 7,205 SLK transplants.…”

Section: Pre-lt Obesitymentioning

confidence: 82%

“…The 1, 3 and 5 year overall patient survival, kidney and liver graft survivals were comparable between the three groups. Multivariate analysis identified diagnosis of hepatitis C, donor age, diabetes mellitus, and delayed kidney transplant function but not BMI as risk factors for poor patient and both liver and kidney graft survival (20). Additionally, a meta-analysis evaluating long-term impact of pre transplant obesity on patient survival in liver transplant recipients showed that BMI does not specifically impact patient survival.…”

Section: Pre-lt Obesitymentioning

confidence: 96%

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Bariatric surgery, obesity and liver transplantation

Ahmed¹,

Khan²,

Vazquez‐Montesino³

et al. 2021

Transl Gastroenterol Hepatol

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The obesity epidemic has profoundly impacted the epidemiology and trends of liver disease.In the current era, non-alcoholic fatty liver disease (NAFLD) progressing to non-alcoholic steatohepatitis (NASH) has emerged as the second leading indication for liver transplant (LT) and has been associated with the rising rates of hepatocellular carcinoma (HCC) with and without underlying cirrhosis. Obesity has been associated with poor post-transplant outcomes including lower patient and graft survival; higher risk of post-operative metabolic complications; poor wound healing; and higher infection rates. Bariatric surgery is currently the most effective management of morbid obesity and has been offered to patients both in the pre and post LT setting. The techniques attempted in LT recipients most commonly include sleeve gastrectomy (SG), gastric bypass surgery with few cases of gastric banding and biliopancreatic diversion. However, there is lack of evidence-based data on the optimal management for patients with obesity and who are liver transplant candidates and/or recipients. In the following discussion, we present the highlights from a review of the literature.

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Section: Pre-lt Obesitymentioning

confidence: 82%

Section: Pre-lt Obesitymentioning

confidence: 96%

Bariatric surgery, obesity and liver transplantation

Ahmed¹,

Khan²,

Vazquez‐Montesino³

et al. 2021

Transl Gastroenterol Hepatol

View full text Add to dashboard Cite

show abstract

“…The proportion of candidates with BMI ≥40 kg/m 2 continued to increase, and approximately one in six candidates (17%) are with BMI ≥35 kg/m 2 . 3 Several studies have reported con icting results on the impact of severe obesity on outcomes of LT. [4][5][6][7][8][9][10][11][12][13][14][15] Some centers and insurance payers have set a cutoff for BMI to list candidates at BMI >40 kg/m 2 . Currently, the American Association for the Study of Liver Disease considers morbid obesity (BMI ≥40 kg/m 2 ) as a relative contraindication for liver transplantation since these patients are at higher risk of post-transplant complications and mortality.…”

Section: Introductionmentioning

confidence: 99%

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

Soma

Park

Mihaylov

et al. 2021

Preprint

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Introduction 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 across the sub-group. Post-transplant BMI was followed up in a smaller cohort of patients receiving LT from January 2008 to December 2018 (n = 1004).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 at long-term follow-up.Conclusion In this study, class Ⅲ obesity is not associated with higher post-transplant 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.

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“…The proportion of candidates with BMI ≥ 40 kg/m2 continued to increase, and approximately one in six candidates (17%) are with BMI > 35 kg/m2. 4 Several studies have reported con icting results on the impact of severe obesity on outcomes of LT. [5][6][7][8][9][10][11][12][13][14][15][16] Some centers and insurance payers have set a cutoff for BMI to list candidates. Currently, the American Association for the Study of Liver Disease, in accordance with the American Society of Transplantation, considers morbid obesity (BMI ≥ 40 kg/m2) as a relative contraindication for liver transplantation, since these patients are at higher risk of post-transplant complications and mortality.…”

Section: Introductionmentioning

confidence: 99%

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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BackgroundOver 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 the impact of severe obesity on outcomes of LT and change in body mass index (BMI) after transplantation.MethodsAll adult LT performed between July 2001 and December 2018 were reviewed. A retrospective analysis was conducted. BMI of recipients is subdivided into six categories: 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.ResultsAmong 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.BMI of all groups except the underweight group declined in the first three months postoperatively. After the three months, 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.ConclusionIn this study, class Ⅲ obesity is not associated with higher mortality. Obesity, including class Ⅲ obesity, should not be considered to be 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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Obesity does not significantly impact outcomes following simultaneous liver kidney transplantation: review of the UNOS database - a retrospective study

Cited by 15 publications

References 37 publications

Bariatric surgery, obesity and liver transplantation

Bariatric surgery, obesity and liver transplantation

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

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

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