New-onset obesity after liver transplantation-outcomes and risk factors: the Swiss Transplant Cohort Study

Abstract

Weight gain after liver transplantation (LTx) facilitates development of new-onset obesity; however, its risk factors and outcomes are poorly understood. We identified the impact of new-onset obesity on cardiovascular events (CVEs) and patient survival, and risk factors for new-onset obesity. Multiple Cox regression models examined risk factors for CVEs, patient survival, and new-onset obesity in 253 adults (mean age 52.2 ± 11.6 years, male gender 63.6%, mean follow up 5.7 ± 2.1 years). Cumulative incidence of post-LTx CVE was 28.1%; that of new-onset obesity was 21.3%. Regardless of CVE at LTx, post-LTx CVEs were predicted by new-onset obesity [Hazard Ratio (HR), 2.95; P = 0.002] and higher age at LTx (HR, 1.05; P < 0.001). In patients without known pre-LTx CVEs (n = 214), risk factors for post-LTx CVEs were new-onset obesity (HR, 2.59; P = 0.014) and higher age (HR, 1.04; P = 0.001). Survival was not associated with new-onset obesity (P = 0.696). Alcoholic liver disease predicted new-onset obesity (HR, 3.37; P = 0.025), female gender was protective (HR, 0.39; P = 0.034). In 114 patients with available genetic data, alcoholic liver disease (HR, 12.82; P = 0.014) and hepatocellular carcinoma (HR, 10.02; P = 0.048) predicted new-onset obesity, and genetics remained borderline significant (HR, 1.07; P = 0.071). Early introduction of post-LTx weight management programs may suggest a potential pathway to reduce CVE risk.

Long Term Follow-up of Liver Transplant Recipients: Considerations for Non-transplant Specialists

“…The cause of postoperative weight gain is multifactorial, an interplay of genetic, physiological, behavioral and environmental factors, similar to posttransplant diabetes and hyperlipidemia. A recent Swiss study [36] identified the following factors associated with post-LT new onset obesity: male gender, alcoholic liver disease, hepatocellular carcinoma at LT, while genetics remained marginal significant. In the same study, post-LT cardiovascular events were predicted by new-onset obesity and higher age at LT.…”

Expert consensus on management of metabolic disease in Chinese liver transplant recipients

“…Studies showed that the incidence of obesity at 1 year and 3 years post transplantation in adult recipients was 23.7% and 30.6%[ 10 , 69 ] respectively, while it was 19% and 18%, respectively, in pediatric recipients[ 11 ]. Obesity is closely associated with the outcome of liver transplant recipients, and overall survival decreases in obese recipients[ 70 ], Moreover, new-onset obesity in liver transplant recipients is closely related to cardiovascular events, infections, and respiratory failure[ 68 , 71 ]. BMI after liver transplantation should be controlled below 30 kg/m 2 and within 25 kg/m 2 as far as possible.…”

Pre‐transplant Social Adaptability Index and clinical outcomes in renal transplantation: The Swiss Transplant Cohort study

“…For instance, educational level and household income have been studied as risk factors for, respectively, sleep quality 34 and new-onset obesity. 35 Other studies have named pre-transplant employment status as a predictor of better post-transplant health (with health levels assumed based on post-transplant employment status) [36][37][38] ; however, prospective, reliably measured indicators of care deprivation-essential tools to identify the full impact of socioeconomic status on general and transplant-specific long-term health outcomes-are lacking. 33 The measurements of the Swiss Transplant Cohort Study (STCS), 39,40 a nationwide open cohort study, cover the SAI's variables, along with subsequently assessed outcomes.…”

“…Despite consensus that transplantation is a chronic health condition that leads to vulnerable long‐term health, 33 Switzerland's solid organ transplant recipients have been largely neglected—certainly in contrast to the general Swiss population—regarding social deprivation and its links with health outcomes. For instance, educational level and household income have been studied as risk factors for, respectively, sleep quality 34 and new‐onset obesity 35 . Other studies have named pre‐transplant employment status as a predictor of better post‐transplant health (with health levels assumed based on post‐transplant employment status) 36–38 ; however, prospective, reliably measured indicators of care deprivation—essential tools to identify the full impact of socioeconomic status on general and transplant‐specific long‐term health outcomes—are lacking 33 .…”