Impact of recipient morbid obesity on outcomes after liver transplantation (original) (raw)
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The Clinical and Financial Impact of Obesity on the Outcome of Liver Transplantation
Transplantation, 2006
The purpose of this study was to determine whether body mass index (BMI) influences the clinical outcomes and overall cost of transplantation in adult liver transplantation (OLT) using records of 700 adult OLT recipients. Patients were divided into BMI range groups over the range of 15 to 42 (mean ϭ 26.7), namely: Ͻ25, n ϭ 288 (41%); 25 to 30, n ϭ 245 (35%); Ն30, n ϭ 167 (24%). Only a small subset of this last group was morbidly obese (BMI Ն 35, n ϭ 37, 5% of total). We did not detect an effect of BMI on patient or graft survival, the incidence of acute graft rejection, or major surgical complications. BMI was not related to length of hospital stay. There were no statistical differences between the three groups with respect to the ratio of overall hospital cost in a general linear model, corrected for age, gender, calculated Model for End-Stage Liver Disease score, retransplant status, or return to the operating room. In conclusion, obesity did not influence either the costs or the clinical outcomes following OLT. Further analysis of the morbidly obese population with respect to cost and outcome is warranted.
Liver Transplantation, 2009
The prevalence of obesity in the general population is increasing in the United States and the rest of the world, and its impact on morbidity, mortality, and utilization of health resources continues to escalate in a significant manner. 1-5 Reports from the Centers for Disease Control and Prevention and the National Health and Nutrition Examination Surveys suggest that more than 20% of the US population is obese [ie, body mass index (BMI) Ͼ 30 kg/m 2 ]. In the past 2 decades, there has been a dramatic increase in the prevalence of obesity among liver transplantation (LT) recipients in the United States. The United Network for Organ Sharing (UNOS) database showed that, from 1988 to 1996, 16.8% of LT recipients had a BMI Ն 30 kg/m 2 ; of these, 5.3% were severely obese (BMI Ն 35 kg/m 2), and 2.1% were morbidly obese (BMI Ն 40 kg/ m 2). 6 The same database (Pelletier et al. 7) showed that, from 2001 to 2004, 32.5% of LT recipients were obese; of these, 8.4% were severely obese, and 3.2% were morbidly obese. Within a decade, it appears that the prevalence of obesity has increased by 93% among LT recipients, and more importantly, there has been a 58% increase in severe obesity as well as a 52% increase in morbid obesity. This increase is mostly a reflection of the changes in the general population and is also possibly due to an increase in the prevalence of nonalcoholic fatty liver disease (or cryptogenic cirrhosis) among Abbreviations: BMI, body mass index; CAD, coronary artery disease; CV, cardiovascular; deltaREE, deviation of measured resting energy expenditure from predicted resting energy expenditure; LT, liver transplantation; UNOS, United Network for Organ Sharing.
World Journal of Hepatology, 2017
AIM To study mortality, length of stay, and total charges in morbidly obese adults during index hospitalization for orthotopic liver transplantation. METHODS The Nationwide Inpatient Sample was queried to obtain demographics, healthcare utilization, post orthotopic liver transplantation (OLT) complications, and short term outcomes of OLT performed from 2003 to 2011 (n = 46509). We divided patients into those with [body mass index (BMI) ≥ 40] and without (BMI < 40) morbid obesity. Multivariable logistic regression analysis was performed
The American journal of gastroenterology, 2001
Severely obese patients who undergo orthotopic liver transplantation are likely to have higher morbidity, mortality, costs, and a lower long-term survival. This case-control study was done at a university hospital. One hundred twenty-one consecutive patients who underwent liver transplantation between 1994 and 1996 were studied. Severe obesity was defined as body mass index (BMI) more than 95th percentile (>32.3 for women and >31.1 for men), and moderate obesity was defined as BMI between 27.3 and 32.3 for women and 27.8 and 31.1 for men. The outcome measures were intraoperative complications, postoperative complications (wound infections, bile leak, vascular complications), length of hospital stay, costs of transplantation, and long-term survival The baseline characteristics, UNOS status, and cause of liver disease at the time of transplantation were similar in severely obese (n = 21, BMI = 37.4+/-4.8 kg/m2), obese (n = 36, BMI 28.7+/-0.9 kg/m2), and nonobese patients (n = 64...
Liver transplantation in the morbidly obese
Journal of Clinical Anesthesia, 1996
Study Objective: To test the hypothesis that morbid obesity implies increased dz;ffulty of liver transplantation and increased risk of adverse outcome. Design: Retrospective review of medical records of 40 morbidly obese patients using a control cohort of patients transplanted just before and after the obese patients. Setting: University medical center. Patients: All morbidly obese patients who underwent liver transplantation over a 5% month period were included. Forty adult patients met criterion for morbid obesity with body mass index greater than 30 kg/m2. Records for 61 time-matched controls were reviewed. Measurements and Main Results: Demographic, intraoperative, and postoperative data were collected including preoperative diagnoses, laboratory and pulmonary function tests, intraoperative transfusion requirements and length of surgey, postoperative complications, and survival. Data were analyzed using Student's t-tests, and Chi-square analyses as appropriate, with significance considered a p-value less than 0.05. Obese patients were more hypoxemic than controls prior to surgery (PaO, 82.9 f 3.5 vs. 93.0 + 3.0 mmHg), were more likely to be diabetic, and had higher creatinine levels (3.0 * 0.6 vs. 1.7 + 0.2 mg/dlJ. Despite this evidence of multi-organ dysfunction, intraoperative and postoperative pulmonary and cardiac complications did not diffu between groups. Though more obese patients had prior cholecystectomy, length of surgery and intraoperative transfusion requirements were not different between groups. Obese patients did not have an increased incidence of reoperation for wound problems, and lengths of intensive care unit and hospital stays did not differ between groups. Graft and patient survival were similar in obese and nonobese liver transplant recipients. Conclusion: Morbid obesity alone does not predispose to increased complications or decreased survival afier liver transplantation. 0 1996 by Elsevier Science Inc.
The impact of wait list body mass index changes on the outcome after liver transplantation
Transplant International, 2013
Obesity is associated with poor health outcomes in the general population, but the evidence surrounding the effect of body mass index (BMI) on postliver transplantation survival is contradictory. The aim of this study was to assess the impact of wait list BMI and BMI changes on the outcomes after liver transplantation. Using the Scientific Registry of Transplant Recipients, we compared survival among different BMI categories and examined the impact of wait list BMI changes on post-transplantation mortality for patients undergoing liver transplantation. Cox proportional hazards multivariate regression was carried out to adjust for confounding factors. Among 38 194 recipients, underweight patients had a poorer survival compared with normal weight (HR = 1.3, 95% CI: 1.13-1.49). Conversely, overweight and mildly obese men experienced better survival rates compared with their lean counterparts (HR = 0.9, 95% CI: 0.84-0.96, and HR = 0.86, 95% CI: 0.79-0.93 respectively). Female patients gaining weight over 18.5 kg/m 2 while on the wait list showed improving outcomes (HR = 0.46, (95% CI: 0.28-0.76)) compared with those remaining underweight. This study supports the harmful impact of underweight on postliver transplant survival, and highlights the need for a specific monitoring and management of candidates with BMIs close to 18.5 kg/m 2 . Obesity does not constitute an absolute contraindication to liver transplantation.
Impact of body mass index on graft failure and overall survival following liver transplant
Clinical Transplantation, 2004
Abstract: Goals: To assess the influence of body mass index (BMI) in the outcome of liver transplantation.Background: Body mass index appears to affect liver transplantation, independently of several risk factors.Study: A review of the United Network for Organ Sharing database included 32 515 liver transplants from 1992 through 2000 with at least one follow-up visit, of which 26 920 had information for determining BMI. The overall impact of elevated BMI (>25), and the impact of increasingly elevated BMI (25–40+) on graft failure rates and overall survival rates are assessed using proportional hazards regression.Results: Controlling for follow-up time, age, gender, race, number of comorbidities, and status 1 designation, the impact of BMI on survival was mixed. The risk of death was elevated for patients with low BMI (<19) and BMI values of ≥40. Compared with patients with BMI of 19–22, those with BMI > 25 had a decreased likelihood of death. This decrease was seen among patients with BMI of 25–34.Conclusion: BMI did not significantly affect rates of graft failure. Compared with patients with a BMI in the ‘normal’ range, those with moderately elevated BMI had decreased likelihood of death while patients with low BMI or extremely high BMI had increased likelihood of death.
Obese and Nonobese Recipients Had Similar Need for Ventilatory Support After Liver Transplantation
Transplantation Proceedings, 2011
Background. Obesity is a risk factor for patients undergoing major surgery. In liver transplantation, the morbidity and mortality in these patients may be higher owing to concomitant diseases that may prolong hospital stay. Moreover, the restrictive respiratory pattern in these patients, associated with pulmonary complications related to liver disease can impact the postoperative recovery. We sought to analyze the impact of high body mass index (BMI) on hospital and intensive care unit (ICU) stay, necessity and length of use either invasive and noninvasive ventilatory support in the early postoperative period after liver transplantation. Patients and Methods. Between January 2007 and March 2009, we performed 85 liver transplantations in adult patients. BMI was calculated on the day of the transplantation. Data from 136 recipients undergoing OLT were reviewed by age, gender, etiology of liver disease, Model for End-Stage Liver Disease score, Child-Pugh class, cold and warm ischemic times, ICU stay, duration of invasive mechanical, and use of noninvasive ventilation (NIV). We divided the patients into 3 groups: Group 1, (normal weight BMI 18.5-24.99), versus group 2 overweight-BMI 25-29.99; versus group 3, obese-BMI Ն30. Results. Groups 1, 2, and 3 had similar lengths of stay in the ICU, necessity of NIV as well as 6 month, 1-and 2-year survivals (P Ͼ .05). Conclusion. High BMI patients showed similar results to normal or overweight patients. Obesity should not be contraindication to liver transplantation.