Effect of Body Mass Index on the Survival Benefit of Liver... : Liver Transplantation (original) (raw)

Original Articles

Pelletier, Shawn J.1,*; Schaubel, Douglas E.2, 3; Wei, Guanghui2; Englesbe, Michael J.1; Punch, Jeffrey D.1; Wolfe, Robert A.3, 4; Port, Friedrich K.3, 4; Merion, Robert M.1, 3

1_Division of Transplantation, Department of Surgery, University of Michigan, Ann Arbor, MI_

2_Department of Biostatistics, University of Michigan, Ann Arbor, MI_

3_Scientific Registry of Transplant Recipients, Ann Arbor, MI_

4_Arbor Research Collaborative for Health, Ann Arbor, MI_

*Address reprint requests to University of Michigan Health System, 2926 Taubman Center, 1500 E. Medical Center Dr., Ann Arbor, MI 48109–0331

E-mail: [email protected]

Received 22 November 2006; accepted 7 March 2007

Published online in Wiley InterScience (www.interscience.wiley.com).

Grant sponsor: Health Resources and Services Administration (HRSA); Grant sponsor: U.S. Department of Health and Human Services; Grant Number: 234–2005–37009C; Grant sponsor: National Institutes of Health; Grant Number: R01 DK-70869.

This study was approved by HRSA's SRTR project officer. HRSA has determined that this study satisfies the criteria for the IRB exemption described in the “Public Benefit and Service Program” provisions of 45 CFR 46.101(b)(5) and HRSA Circular 03.

Telephone: 734–936–8363; FAX: 734–763–3187

Abstract

Obese patients are at higher risk for morbidity and mortality after liver transplantation (LT) than nonobese recipients. However, there are no reports assessing the survival benefit of LT according to recipient body mass index (BMI). A retrospective cohort of liver transplant candidates who were initially wait-listed between September 2001 and December 2004 was identified in the Scientific Registry of Transplant Recipients database. Adjusted Cox regression models were fitted to assess the association between BMI and liver transplant survival benefit (posttransplantation vs. waiting list mortality). During the study period, 25,647 patients were placed on the waiting list. Of these, 4,488 (17%) underwent LT by December 31, 2004. At wait-listing and transplantation, similar proportions were morbidly obese (BMI ≥ 40; 3.8% vs. 3.4%, respectively) and underweight (BMI < 20; 4.5% vs. 4.0%, respectively). Underweight patients experienced a significantly higher covariate-adjusted risk of death on the waiting list (hazard ratio [HR] = 1.61; P < 0.0001) compared to normal weight candidates (BMI 20 to <25), but underweight recipients had a similar risk of posttransplantation death (HR = 1.28; P = 0.15) compared to recipients of normal weight. In conclusion, compared to patients on the waiting list with a similar BMI, all subgroups of liver transplant recipients demonstrated a significant (P < 0.0001) survival benefit, including morbidly obese and underweight recipients. Our results suggest that high or low recipient BMI should not be a contraindication for LT. Liver Transpl, 2007. © 2007 AASLD.