Obesity: Weighty Challenges for the Liver Transplant Community

Selzner, Nazia; Grant, David

doi:10.1002/lt.25437

Liver Transpl

2019

DOI: 10.1002/lt.25437

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Obesity: Weighty Challenges for the Liver Transplant Community

Nazia Selzner

David Grant

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2022

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Cited by 1 publication

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“…5 NASH, a well-described complication of obesity, is expected to become the leading indication for transplantation within the next decade. 6 Elevated BMI has been implicated in a variety of surgical risks. For example, some studies have associated obesity with surgical site infections following abdominal procedures.…”

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Is Obesity Associated With Better Liver Transplant Outcomes? A Retrospective Study of Hospital Length of Stay and Mortality Following Liver Transplantation

Du¹,

Danforth²,

Waterman³

et al. 2022

Anesthesia &Amp; Analgesia

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BACKGROUND:The rise in obesity in the United States, along with improvements in antiviral therapies, has led to an increase in the number of obese patients receiving liver transplants. Currently, obesity is a relative contraindication for liver transplant, although exact body mass index (BMI) limits continue to be debated. Studies conflict regarding outcomes in obese patients, while some argue that BMI should not be used as an exclusion criterion at all. Therefore, this retrospective study-utilizing a large national database-seeks to elucidate the association between recipient BMI and hospital length of stay and mortality following liver transplant. METHODS: A retrospective study was conducted using the United Network for Organ Sharing Standard Transplant Analysis and Research database. Fine-Gray competing risk regressions were used to explore the association between BMI and rate of discharge, which varies inversely with length of stay. In our model, subdistribution hazard ratio (SHR) represented the relative change in discharge rate compared to normal BMI, with in-hospital death was considered as a competing event for live discharge. Cox proportional hazard models were built to assess the association of BMI category on all-cause mortality after liver transplantation. Cluster-robust standard errors were used in all analyses to construct confidence intervals. RESULTS: Within the final sample (n = 47,038), overweight (≥25 and <30 kg/m 2 ) patients comprised the largest BMI group (34.7%). The competing risk regression model showed an association for increased length of stay among underweight (SHR = 0.82, 95% confidence interval [CI], 0.77-0.89; P < .001) and class 3 obesity patients (SHR = 0.88, 95% CI, 0.83-0.94; P < .001), while overweight (SHR = 1.05, 95% CI, 1.03-1.08; P < .001) and class 1 obesity (SHR = 1.04, 95% CI, 1.01-1.07; P = .01) were associated with decreased length of stay. When the sample excluded patients with low pretransplant functional status, however, length of stay was not significantly shorter for overweight and obesity class 1 patients. Cox proportional hazard models demonstrated increased survival among overweight, class 1 and class 2 obesity patients and decreased survival among underweight patients. CONCLUSIONS: Our results provide evidence that overweight and obesity class 1 are associated with decreased length of stay and mortality following liver transplant, while underweight and obesity class 3 are associated with prolonged length of stay. Pretransplant functional status may contribute to outcomes for overweight and class 1 obese patients, which necessitates continued investigation of the isolated impact of BMI in those who have had a liver transplant. (Anesth Analg 2022;135:118-27) KEY POINTS• Question: Is recipient obesity before liver transplant associated with prolonged hospital length of stay or increased mortality? • Findings: Overweight and obesity class 1 are associated with decreased length of stay and longterm mortality, while obesity class 3 and underweight are associate...

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mentioning

confidence: 99%

“…5 NASH, a well-described complication of obesity, is expected to become the leading indication for transplantation within the next decade. 6…”

mentioning

confidence: 99%

Is Obesity Associated With Better Liver Transplant Outcomes? A Retrospective Study of Hospital Length of Stay and Mortality Following Liver Transplantation

Du¹,

Danforth²,

Waterman³

et al. 2022

Anesthesia &Amp; Analgesia

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show abstract

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Obesity: Weighty Challenges for the Liver Transplant Community

Cited by 1 publication

References 10 publications

Is Obesity Associated With Better Liver Transplant Outcomes? A Retrospective Study of Hospital Length of Stay and Mortality Following Liver Transplantation

Is Obesity Associated With Better Liver Transplant Outcomes? A Retrospective Study of Hospital Length of Stay and Mortality Following Liver Transplantation

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