Survival Analysis of Obese Patients Undergoing Liver Transplantation

Boin, I.F.S.F.; Almeida, L.V.; Udo, E.Y.; Stucchi, R.S.B.; Cardoso, Almino Ramos; Caruy, C.A.; Leonardi, M.I.; Leonardi, Lorenzo

doi:10.1016/j.transproceed.2007.08.101

Cited by 15 publications

(14 citation statements)

References 8 publications

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“…Our results are consistent with previous work finding that obesity does not worsen mortality after liver transplantation . Recent studies in liver transplant patients have similarly indicated that obesity is not associated with an increased length of stay in the ICU, ventilator support, or 2‐year mortality after liver transplantation . Sawyer et al did not find an increase in mortality, but they observed increased infection and multisystem organ failure rates in an acute setting in patients with a BMI > 35 kg/m 2 .…”

Section: Discussionsupporting

confidence: 92%

“…[21][22][23][24] Recent studies in liver transplant patients have similarly indicated that obesity is not associated with an increased length of stay in the ICU, ventilator support, or 2-year mortality after liver transplantation. 25,26 Sawyer et al 21 did not find an increase in mortality, but they observed increased infection and multisystem organ failure rates in an acute setting in patients with a BMI > 35 kg/m 2 . A Danish study reported that a BMI > 30 kg/m 2 increased mortality; however, the comparison groups in that analysis were poorly matched.…”

Section: Discussionmentioning

confidence: 96%

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Comparable graft and patient survival in lean and obese liver transplant recipients

et al. 2013

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Obesity is among the great health problems facing Americans today. More than 32% of the US population is considered obese on the basis of a body mass index (BMI) exceeding 30 kg/m 2 . Obesity increases the risk for numerous perioperative complications, but how obesity affects the outcome of liver transplantation remains unclear. We compared graft/patient survival after orthotopic liver transplantation performed at the Cleveland Clinic between April 2005 and June 2011 in 2 groups: obese patients with a BMI 38 kg/m 2 and lean patients with a BMI between 20 and 26 kg/m 2 . We included 47 obese patients and 183 lean patients, whose demographics and baseline characteristics were well balanced after weighting with the inverse propensity score. After we controlled for observed confounding, no significant differences were observed in graft/patient survival between obese and lean patients (P 5 0.30). The estimated hazard ratio for obese patients to experience graft failure or death was 1.19 [95% confidence interval (CI) 5 0.85-1.67]. There were 134 patients who had follow-up for more than 3 years, and they included 27 obese patients and 107 lean patients. Within this subset, the odds of having metabolic syndrome were significantly greater for obese patients (46%) versus lean patients (21%; odds ratio 5 4.76, 99.5% CI 5 1.66-13.7, P < 0.001). However, no significant association between obesity and any other long-term adverse outcomes was found. In conclusion, this study shows that transplant outcomes were comparable for lean and obese recipients. We thus recommend that even morbid obesity per se should not exclude patients from consideration for transplantation. Liver

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 96%

Comparable graft and patient survival in lean and obese liver transplant recipients

et al. 2013

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“…Single-center studies that have been published from the United States and other European countries, with sample sizes ranging from 167 to 813 patients, have shown variable results for graft and patient survival. [7][8][9][10][11][12][13][14][15][16][17] Although some single-center studies have shown no effect of obesity on graft and patient survival, [7][8][9][10][11] others have reported reduced graft survival and overall increased mortality in obese and morbidly obese recipients. [12][13][14][15][16][17] Three large transplant registry studies of the United Network for Organ Sharing database have been published over the past 10 years.…”

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confidence: 99%

Increased morbidity in overweight and obese liver transplant recipients: A single-center experience of 1325 patients from the United Kingdom

et al. 2013

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Obesity levels in the United Kingdom have risen over the years. Studies from the United States and elsewhere have reported variable outcomes for obese liver transplant recipients in terms of post-liver transplant morbidity, mortality, and graft survival. ). The primary outcome was an evaluation of graft and patient survival, and the secondary outcome was an assessment of postoperative morbidity. Bonferroni correction was applied with statistical significance set at P < 0.012. Kaplan-Meier curves were used to study the effects of BMI on graft and patient survival. A total of 1325 patients were included in the study: underweight (n 5 47 or 3.5%), normal-weight (n 5 643 or 48.5%), overweight (n 5 417 or 31.5%), obese (n 5 145 or 10.9%), and morbidly obese patients (n 5 73 or 5.5%). The rate of postoperative infective complications was significantly higher in the overweight (60.7%, P < 0.01) and obese recipients (65.5%, P < 0.01) versus the normal-weight recipients (50.4%). The morbidly obese patients had a longer mean intensive care unit (ICU) stay than the normal-weight patients (4.7 versus 3.2 days, P 5 0.03). The mean hospital stay was longer for the overweight (22.4 days, P < 0.001), obese (21.3 days, P 5 0.04), and morbidly obese recipients (22.4 days, P 5 0.047) versus the normal-weight recipients (18.0 days). There was no difference in death-censored graft survival or patient survival between the groups. In conclusion, this is the largest and only reported UK series on BMI and outcomes following liver transplantation. Overweight and obese patients have significantly increased morbidity in terms of infective complications after liver transplantation and, consequently, longer ICU and hospital stays.

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“…The impact of obesity on posttransplant outcomes is unclear. Although a large database from the United Network for Organ Sharing showed a link between obesity and increased mortality and graft failure after OLT, other studies, some of which controlled for ascites, did not suggest any relationship . In a study by Agopian et al, NAFLD patients with a BMI greater than 35 kg/m 2 had decreased graft and patient survival.…”

mentioning

confidence: 97%

“…Although a large database from the United Network for Organ Sharing showed a link between obesity and increased mortality and graft failure after OLT, other studies, some of which controlled for ascites, did not suggest any relationship. [8][9][10][11][12][13][14] In a study by Agopian et al, 15 NAFLD patients with a BMI greater than 35 kg/m 2 had decreased graft and patient survival. Other studies demonstrated that high-risk NAFLD patients (BMI > 30 kg/m 2 , age > 60 years, and presence of diabetes and hypertension before transplantation) had a significantly lower survival rate in comparison with other NAFLD patients.…”

mentioning

confidence: 98%

Weight gain after orthotopic liver transplantation: Is nonalcoholic fatty liver disease cirrhosis a risk factor for greater weight gain?

et al. 2014

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Posttransplant weight gain is common after orthotopic liver transplantation. We sought to determine the extent of weight gain at 5 years after transplantation in patients with nonalcoholic fatty liver disease (NAFLD) cirrhosis versus patients with other types of cirrhosis (non-NAFLD). We studied 126 liver transplants performed between 2005 and 2007 at Saint Luc Hospital, University of Montreal. Seventeen of the 126 patients (13.5%) had NAFLD cirrhosis. Ascites volume was difficult to assess, so we used the body mass index (BMI) at 3 months as the reference BMI. All patients gained weight after transplantation, but BMI increased significantly more and earlier among the NAFLD patients [4.8 versus 1.5 kg/m 2 at 1 year (P 5 0.001), 5.0 versus 2.3 kg/m 2 at 2 years (P 5 0.01), and 5.6 versus 2.6 kg/m 2 at 5 years (P 5 0.009)] in comparison with non-NAFLD patients in unadjusted analyses. The greatest BMI increase over time was investigated with univariate and multivariate logistic regression analyses. The BMI increase was divided into tertiles for each period of time observed. The greatest BMI increase over time was defined as the top tertile of BMI increase. After adjustments for potential confounders (ie, total cholesterol, diabetes, and length of hospital stay), NAFLD was no longer associated with a risk of a greater BMI increase [odds ratio (OR) 5 3.73 at 1 year (P 5 0.11), OR 5 2.15 at 2 years (P 5 0.34), and OR 5 2.87 at 5 years (P 5 0.30)]. These findings suggest the need for multidisciplinary, early, and close weight monitoring for all patients. All patients could benefit from pretransplant counseling regarding weight gain and its consequences.

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Survival Analysis of Obese Patients Undergoing Liver Transplantation

Cited by 15 publications

References 8 publications

Comparable graft and patient survival in lean and obese liver transplant recipients

Comparable graft and patient survival in lean and obese liver transplant recipients

Increased morbidity in overweight and obese liver transplant recipients: A single-center experience of 1325 patients from the United Kingdom

Weight gain after orthotopic liver transplantation: Is nonalcoholic fatty liver disease cirrhosis a risk factor for greater weight gain?

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