Obesity Management of Liver Transplant Waitlist Candidates and Recipients

Brandman, Danielle

doi:10.1016/j.cld.2020.08.001

Cited by 12 publications

(13 citation statements)

References 144 publications

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“…[13] Although obesity may be associated with increased peritransplant morbidity, it does not seem to increase post-transplant mortality. [14] LT needs to be thoughtful, with an emphasis on improving nutritional status and muscle mass in this patient population due to their risk of malnutrition. [3] In those listed for transplant, nutritional assessment should occur as soon as possible to improve protein status before transplant.…”

Section: Pre-ltmentioning

confidence: 99%

“…[3,13,14] The American Association for the Study of Liver Diseases recommends multidisciplinary team management involving the patient's primary care provider, gastroenterologist/hepatologist, registered dietician, physical therapist, and health behavior specialist. [14] It should also be noted that although the traditional definition of obesity is based on BMI, this index is limited by its inability to assess the proportions of fat mass and lean mass. Therefore, in patients with cirrhosis, the use of BMI as a classification system for obesity is limited due to the presence of ascites and sarcopenia.…”

Section: Pre-ltmentioning

confidence: 99%

“…As frailty and sarcopenia are associated with hepatic decompensation, increased health care use, worse quality of life, adverse post-transplant outcomes, and increased overall risk of death in patients with cirrhosis, recognition, and treatment of obesity in this population are important 13 . Although obesity may be associated with increased peritransplant morbidity, it does not seem to increase post-transplant mortality 14 …”

Section: Pre-ltmentioning

confidence: 99%

“…In those listed for transplant, nutritional assessment should occur as soon as possible to improve protein status before transplant 15 . Personalized physical activity programs to improve muscle mass are also recommended 3,13,14 . The American Association for the Study of Liver Diseases recommends multidisciplinary team management involving the patient’s primary care provider, gastroenterologist/hepatologist, registered dietician, physical therapist, and health behavior specialist 14 .…”

Section: Pre-lt Managementmentioning

confidence: 99%

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Obesity management for the pre–liver transplant and post–liver transplant patient

Ahlers

Kappus

2023

Clinical Liver Disease

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Obesity is associated with an increased risk of death while awaiting liver transplantation. Diet and exercise are the cornerstones of obesity treatment in patients listed for liver transplantation. Surgical management of obesity in patients awaiting liver transplantation can be considered pre-, post-, or simultaneous to liver transplantation. PRE-LT MANAGEMENTDiet and exercise are the cornerstones of obesity treatment in patients listed for transplant. [3] The approach to weight loss for obese patients awaiting

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Section: Pre-ltmentioning

confidence: 99%

Section: Pre-ltmentioning

confidence: 99%

Section: Pre-ltmentioning

confidence: 99%

Section: Pre-lt Managementmentioning

confidence: 99%

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Obesity management for the pre–liver transplant and post–liver transplant patient

Ahlers

Kappus

2023

Clinical Liver Disease

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“…Approximately 20%–35% of patients with cirrhosis develop sarcopenic obesity as a result of concurrent loss of skeletal muscle mass and gain of adipose tissue 1–3. These rates will likely continue to increase in light of the obesity epidemic and the aging of patients with cirrhosis 4–6. The concordance of these 2 conditions is associated with higher rates of pretransplant/post-transplant morbidity and mortality than seen with either sarcopenia or obesity alone 1,3,7–9.…”

Section: Introductionmentioning

confidence: 99%

CT-quantified sarcopenic visceral obesity is associated with poor transplant waitlist mortality in patients with cirrhosis

Fan

Shui

et al. 2023

Liver Transplantation

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Sarcopenic obesity is associated with higher rates of morbidity and mortality than seen with either sarcopenia or obesity alone. We aimed to define sarcopenic visceral obesity (SVO) using CT-quantified skeletal muscle index and visceral-to-subcutaneous adipose tissue ratio and to examine its association with waitlist mortality in patients with cirrhosis. Included were 326 adults with cirrhosis awaiting liver transplantation in the ambulatory setting with available abdominal CT within 6 months from enrollment between February 2015 and January 2018. SVO was defined as patients with sarcopenia (skeletal muscle index <50 cm2/m2 in men and <39 cm2/m2 in women) and visceral obesity (visceral-to-subcutaneous adipose tissue ratio ≥1.21 in men and ≥0.48 in women). The percentage who met criteria for sarcopenia, visceral obesity, and SVO were 44%, 29%, and 13%, respectively. Cumulative incidence of waitlist mortality was higher in patients with SVO compared to patients with sarcopenia without visceral obesity or visceral obesity without sarcopenia at 12 months (40% vs. 21% vs. 12%) (overall logrank p=0.003). In univariable Cox regression, SVO was associated with waitlist mortality (HR: 3.42, 95% CI: 1.58–7.39), which remained significant after adjusting for age, sex, diabetes, ascites, encephalopathy, MELDNa, liver frailty index, and different body compositions (HR: 2.64, 95% CI: 1.11–6.30). SVO was associated with increase waitlist mortality in patients with cirrhosis in the ambulatory setting awaiting liver transplantation. Concurrent loss of skeletal muscle and gain of adipose tissue seen in SVO quantified by CT may be a useful and objective measurement to identify patients at risk for suboptimal pretransplant outcomes.

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