Obesity and liver transplantation

Ayloo, Subhashini; Armstrong, John N.; Hurton, Scott; Molinari, Michele

doi:10.5500/wjt.v5.i3.95

Cited by 20 publications

(16 citation statements)

References 41 publications

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“…Dieting, medications, physical activity, and behavioral therapy to address obesity prior to LT are acceptable but often poorly effective or tolerated given the severity of patients’ liver disease [17]. Another option that has been used to address the possible negative impact of obesity on LT is bariatric surgery (BS).…”

Section: Nafld Cirrhosis: a Uniquely Challenging Lt Patientmentioning

confidence: 99%

Nonalcoholic Fatty Liver Disease: Key Considerations Before and After Liver Transplantation

2016

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Nonalcoholic fatty liver disease (NAFLD) is the most common etiology of chronic liver disease in developed countries and is on trajectory to become the leading indication for liver transplantation in the USA and much of the world. Patients with NAFLD cirrhosis awaiting liver transplant face unique challenges and increased risk for waiting list stagnation and dropout due to burdensome comorbidities including obesity, diabetes, cardiovascular disease, and kidney disease. Thus far, patients transplanted for NAFLD cirrhosis have excellent mid-and long-term patient and graft survival, but concerns regarding short-term morbidity and mortality continue to exist. Post-liver transplantation, NAFLD occurs as both a recurrent and de novo manifestation, each with unique outcomes. NAFLD in the donor population is of concern given the growing demand for liver transplantation and mounting pressure to expand the donor pool. This review addresses key issues surrounding NAFLD as an indication for transplantation, including its increasing prevalence, unique patient demographics, outcomes related to liver transplantation, development of post-liver transplantation NAFLD, and NAFLD in the liver donor population. It also highlights exciting areas where further research is needed, such as the role of bariatric surgery and preconditioning of marginal donor grafts.

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Section: Nafld Cirrhosis: a Uniquely Challenging Lt Patientmentioning

confidence: 99%

Nonalcoholic Fatty Liver Disease: Key Considerations Before and After Liver Transplantation

2016

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“…Not only is obesity a modifiable risk factor for cardiovascular adverse events, which accounted for 9.9% of deaths in our study, but it is also a major contributor to NASH, which is becoming an increasingly common indication of LT. In addition to lifestyle changes and medically-supervised weight loss, the role of metabolic surgery needs to be explored very early in the course of liver failure[ 28 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

Trends of characteristics and outcomes of donors and recipients of deceased donor liver transplantation in the United States: 1990 to 2013

Ayloo¹,

Pentakota²,

Molinari³

2018

WJT

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AIMTo compare trends in donor/recipient characteristics and outcomes using four period cohorts of liver transplant recipients from 1990 to 2009.METHODSSeventy thousand three hundred and seventy-seven adult first-time recipients of whole-organ deceased-donor liver grafts from 1990 to 2009 were followed up until September 2013. Four periods based on transplantation dates were considered to account for developments in transplantation. Descriptive statistics were used to describe donor/recipient characteristics and transplant outcomes. Statistical comparisons between periods were performed using χ2/Fischer’s exact test (categorical variables) and t-tests/Mann-Whitney U test (continuous variables). Univariate descriptive statistics/survival data were generated using Kaplan-Meier curves. Cox Proportional Hazards models were used for regression analyses of patient and graft survival.RESULTSMean age (years), body mass index (kg/m2), and the proportion of males were, respectively, 39.1 (± 17.4), 25.9 (± 5.7) and 60.3 for donors, and 51.3 (± 10.5), 27.7 (± 5.6), and 64.4 for recipients. Donor and transplantation rates differed between racial/ethnic groups. Median (Q1-Q3) cold and warm ischemia, waitlist, and hospital stay times were 8 (6.0-10.0) h and 45 (35-59) min, 93 (21-278) d, and 12 (8-20) d. Total functional assistance was required by 8% of recipients at wait-listing and 13.4% at transplantation. Overall survival at 1, 3, 5, 10, 15, and 20 years was 87.3%, 79.4%, 73.6%, 59.8%, 46.7%, and 35.9%, respectively. The 2005-2009 cohort had better patient and graft survival than the 1990-1994 cohort overall [HR 0.67 (0.62-0.72) and 0.66 (0.62-0.71)] and at five years [HR 0.73 (0.66-0.80) and 0.71 (0.65-0.77)].CONCLUSIONDespite changes in donor quality, recipient characteristics, and declining functional status among transplant recipients, overall patient survival is superior and post-transplant outcomes continue to improve.

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“…Therefore, NAFLD patients considered for transplant, or on the transplant list, should be especially targeted for these focused approaches given their advanced state of disease. However, medically supervised weight-loss programs have traditionally had low success rates and often do not result in sustained weight loss, leaving more to be desired [16] . Bariatric surgery (BS) represents an opportunity to address comorbid obesity in cirrhotic patients and to improve outcomes of liver transplantation for obese NAFLD patients, as well as possibly for obese patients with other etiologies of end-stage liver disease.…”

Section: Research Highlightmentioning

confidence: 99%

Liver Transplantation for Nonalcoholic Fatty Liver Disease: Role of Bariatric Surgery for Comorbid Obesity

Patel

2016

J Adv Nutr Hum Metab

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Nonalcoholic fatty liver disease (NAFLD) is an increasingly prevalent form of chronic liver disease throughout the world and is associated with substantial morbidity and mortality related to liver disease and the consequences of metabolic syndrome. NAFLD is projected to become the leading indication for liver transplantation in the United States in the near future, and presents unique challenges due to common comorbidities, particularly obesity. As obesity is often a barrier to transplant, distinctive decision-making and care is needed for this growing population. Bariatric surgery offers a promising option for liver transplant specialists to consider in obese patients with NAFLD cirrhosis. This research highlight reviews the rising burden of NAFLD, concerns regarding obesity and liver transplant, and the potential role of bariatric surgery in the liver transplantation paradigm.Keywords: NAFLD; Cirrhosis; Obesity; Liver Transplantation; Bariatric Surgery To cite this article: Yuval A. Patel, et al. Liver transplantation for nonalcoholic fatty liver disease: role of bariatric surgery for comorbid obesity.

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Obesity and liver transplantation

Cited by 20 publications

References 41 publications

Nonalcoholic Fatty Liver Disease: Key Considerations Before and After Liver Transplantation

Nonalcoholic Fatty Liver Disease: Key Considerations Before and After Liver Transplantation

Trends of characteristics and outcomes of donors and recipients of deceased donor liver transplantation in the United States: 1990 to 2013

Liver Transplantation for Nonalcoholic Fatty Liver Disease: Role of Bariatric Surgery for Comorbid Obesity

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