Reexamining the Association of Body Mass Index With Overall Survival Outcomes After Liver Transplantation

Chang, Su‐Hsin; Liu, Xiaoyan; Carlsson, Nils P.; Park, Yikyung; Colditz, Graham A.; Garonzik-Wang, Jacqueline M; Chapman, William C.; Wellen, Jason R.; Doyle, Maria B. Majella; Alhamad, Tarek

doi:10.1097/txd.0000000000000681

Cited by 12 publications

(11 citation statements)

References 52 publications

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“…Since the influence of obesity on overall survival post-LT is controversially discussed ( 14 , 15 ), we first focused on donor BMI as a potential risk factor to impact liver graft quality. Recently, we illustrated that the natural cytotoxicity receptor NKG2D is a marker of renal senescence and correlates with allograft function ( 8 ).…”

Section: Resultsmentioning

confidence: 99%

Expression of MICA in Zero Hour Biopsies Predicts Graft Survival After Liver Transplantation

et al. 2021

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In search for novel biomarkers to assess graft quality, we investigated whether defined candidate genes are predictive for outcome after liver transplantation (LT).Zero-hour liver biopsies were obtained from 88 livers. Gene expression of selected candidate markers was analyzed and correlated with clinical parameters as well as short and long-term outcomes post LT. Whereas both, the calculated Eurotransplant Donor-Risk-Index and the donor body mass index, had either a poor or no predictive value concerning serum levels indicative for liver function (ALT, AST, GGT, bilirubin) after 6 months, chronological donor age was weakly predictive for serum bilirubin (AUC=0.67). In contrast, the major histcompatibility complex class I related chain A (MICA) mRNA expression demonstrated a high predictive value for serum liver function parameters revealing an inverse correlation (e.g. for ALT: 3 months p=0.0332; 6 months p=0.007, 12 months 0.0256, 24 months p=0.0098, 36 months, p=0.0153) and proved significant also in a multivariate regression model. Importantly, high expression of MICA mRNA revealed to be associated with prolonged graft survival (p=0.024; log rank test) after 10 years of observation, whereas low expression was associated with the occurrence of death in patients with transplant related mortality (p=0.031). Given the observed correlation with short and long-term graft function, we suggest MICA as a biomarker for pre-transplant graft evaluation.

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Section: Resultsmentioning

confidence: 99%

Expression of MICA in Zero Hour Biopsies Predicts Graft Survival After Liver Transplantation

et al. 2021

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“…In a cohort of 115 473 patients who underwent liver transplant, recipients with BMI between 25 and 40 kg/m 2 had lower mortality risk compared to their normal weight counterparts; however, the best post‐liver transplant survival was observed in patients with the moderate body weight excess (BMI of 28 to 37 kg/m 2 ), indicating a nonlinear relationship between BMI and post‐liver transplant survival. Stratification by the MELD score, showed a higher BMI was related to improved survival in patients with MELD 19 to 25; with no association between BMI and MELD in patients with scores >25 18 . Despite longer hospitalisation and shorter survival in patients on either extreme of BMI (<18.5 kg/m 2 or >40 kg/m 2 ), liver transplant in extremely obese patients with lower MELD scores (≤22) considerably enhanced patient survival 12 .…”

Section: Methodsmentioning

confidence: 98%

Review article: prognostic significance of body composition abnormalities in patients with cirrhosis

Ebadi

Bhanji

Tandon

et al. 2020

Aliment Pharmacol Ther

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Summary Background Recent advances in evaluation of body composition show body mass index to be inadequate in differentiating between body compartments in cirrhosis. Given the limitations of body mass index, body composition evaluation using computed tomography has been increasingly used as a non‐invasive clinical tool with prognostic value. Another factor influencing prognosis includes sex‐specific differences in body composition that are seen in cirrhosis. Aim To review current knowledge regarding the frequency and clinical implications of abnormal body composition features in cirrhosis. Methods We searched PubMed database and limited the literature search to full‐text papers published in English. Studies using inappropriate landmarks or demarcation of body composition components on computed tomography images were eliminated. Results Sarcopenia is a well established factor affecting morbidity and mortality in cirrhosis. Other important body composition components that have been overlooked thus far include subcutaneous adipose tissue and visceral adipose tissue. Female patients with cirrhosis and low subcutaneous adiposity have a higher risk of mortality, whereas male patients with high visceral adiposity have a higher risk of hepatocellular carcinoma and recurrence following liver transplantation. Increased adipose tissue radiodensity has been associated with risk of decompensation and mortality. Conclusions Further evaluation of body composition abnormalities may help with development of targeted therapeutic strategies and improve outcome in patients with cirrhosis. Moreover, recognition of these abnormalities could improve prioritisation for liver transplantation as our current method based solely on liver function might lead to risk misclassification.

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“…Using CT estimates of muscle mass, DiMartini et al found that 62% of pre-transplant patients with a BMI >25 (including both overweight and obese patients) were simultaneously sarcopenic, while 80% of cirrhotic patients with a "normal" BMI of 18.5-25 were also sarcopenic (21). In a retrospective analysis of 48,226 patients who had undergone liver transplant between 2002 and 2013 (Organ Procurement and Transplantation Network database), Chang et al reported best survival outcomes for patients with a BMI of 28-37, even after stratifying for MELD score, suggesting that patients listed for transplant may do better if they are able to maintain some of their BMI weight in the pre-transplant period (22). Moreover, they found that the relationship between BMI and mortality after transplant was "U"-shaped, with highest mortality risk at the extremes of BMI (<19 and >40), with a nadir (least mortality) at a BMI of 34.…”

Section: Post-transplant Outcomesmentioning

confidence: 99%

Implications of pre-transplant sarcopenia and frailty in patients with non-alcoholic steatohepatitis and alcoholic liver disease

Redman¹,

Kaspar²,

Puri³

2022

Transl Gastroenterol Hepatol

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Frailty manifesting as sarcopenia is an independent risk factor for mortality in cirrhosis, and often presents in low model for end-stage liver disease (MELD) patients. Its etiology is multifactorial, but key physiologic changes culminate in altered energy utilization in the fasting state, preferentially utilizing muscle amino acids for gluconeogenesis thereby promoting sarcopenia. Hyperammonemia alters the circulating amino acid profile, diminishing pro-muscle branched-chain amino acids like leucine. The metabolic syndrome worsens sarcopenia through multi-tissue insulin resistance. Alcohol also exacerbates sarcopenia as a direct muscle toxin and inhibitor of growth signaling. Therapy is aimed at alcohol cessation, frequent highprotein meals, branched-chain amino acid supplementation, and diminished time spent fasting. Moderate exercise can improve muscle mass and muscle quality, though precise exercise regimens have not yet been explicitly determined. Studies are ongoing into the effects of myostatin antagonists and insulin sensitizers.The Liver Frailty Index can predict patients most at risk of poor outcome and should be considered in the management of all cirrhotic patients. Specialty testing like dual-energy X-ray absorptiometry (DEXA) scanning and cross-sectional estimates of muscle mass are areas of active research and may play a future role in clinical risk-stratification.

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Reexamining the Association of Body Mass Index With Overall Survival Outcomes After Liver Transplantation

Abstract: Supplemental digital content is available in the text.

Cited by 12 publications

References 52 publications

Expression of MICA in Zero Hour Biopsies Predicts Graft Survival After Liver Transplantation

Expression of MICA in Zero Hour Biopsies Predicts Graft Survival After Liver Transplantation

Review article: prognostic significance of body composition abnormalities in patients with cirrhosis

Implications of pre-transplant sarcopenia and frailty in patients with non-alcoholic steatohepatitis and alcoholic liver disease

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