Association of body mass index with post‐liver transplant outcomes

Author:

Ruck Jessica M.1ORCID,Shui Amy M.2,Jefferis Alexis A.1,Duarte Rojo Andres3,Rahimi Robert S.4,Ganger Daniel R.56,Verna Elizabeth C.7,Kappus Matthew8,Ladner Daniela P.69,Segev Dorry L.1011,Volk Michael12,Tevar Amit13,King Elizabeth A.1,Lai Jennifer C.13ORCID

Affiliation:

1. Department of Surgery Johns Hopkins University School of Medicine Baltimore Maryland USA

2. Department of Epidemiology and Biostatistics University of California San Francisco San Francisco California USA

3. Center for Liver Diseases, Thomas A. Starzl Transplantation Institute Pittsburgh Liver Research Center, University of Pittsburgh Pittsburgh Pennsylvania USA

4. Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center Baylor Scott and White Health Dallas Texas USA

5. Division of Gastroenterology and Hepatology, Department of Medicine Northwestern Medicine Chicago Illinois USA

6. Comprehensive Transplant Center, Feinberg School of Medicine Northwestern University Chicago Illinois USA

7. Center for Liver Disease and Transplantation Columbia University Irving Medical Center New York New York USA

8. Division of Gastroenterology, Department of Medicine Duke University School of Medicine Durham North Carolina USA

9. Division of Transplantation, Department of Surgery Northwestern Medicine Chicago Illinois USA

10. Department of Surgery New York University Grossman School of Medicine and Langone Health New York New York USA

11. Department of Population Health New York University Grossman School of Medicine and Langone Health New York New York USA

12. Division of Gastroenterology & Hepatology, and Transplantation Institute Loma Linda University Health Loma Linda California USA

13. Department of Medicine University of California San Francisco School of Medicine San Francisco California USA

Abstract

AbstractBackgroundPatients with obesity have inferior outcomes after general surgery procedures, but studies evaluating post‐liver transplant (LT) outcomes have been limited by small sample sizes or lack of granularity of outcomes. We evaluated the relationship between obesity and post‐LT outcomes, including those observed in other populations to be obesity‐related.MethodsIncluded were 1357 LT recipients prospectively enrolled in the ambulatory pre‐LT setting at 8 U.S. centers. Recipient were categorized by body mass index (BMI, kg/m2): non‐obese (BMI < 30), class 1 obesity (BMI 30–<35), and classes 2–3 obesity (BMI ≥ 35). Post‐transplant complications were compared by BMI using Chi‐square and rank‐sum testing, logistic regression, Kaplan‐Meier curves, and Cox regression.ResultsClasses 2–3 obesity was associated with higher adjusted odds than non‐obesity of venous thrombosis [adjusted odds ratio (aOR) 2.06, 95% CI 1.01–4.23, p = .047] and wound dehiscence (aOR 2.45, 95% CI 1.19–5.06, p = .02). Compared with non‐obese recipients, post‐LT hospital stay was significantly longer for recipients with classes 2–3 obesity [p = .01; median (Q1–Q3) 9 (6–14) vs. 8 (6–12) days) or class 1 obesity [p = .002; 9 (6–14) vs. 8 (6–11) days].  Likelihood of ICU readmission, infection, discharge to a non‐home facility, rejection, 30‐day readmission, and 1‐year readmission were similar across BMI categories (all p > .05).ConclusionCompared to non‐obese recipients, obese recipients had similar post‐LT survival but longer hospital stay and higher likelihood of wound dehiscence and venous thrombosis. These findings underscore that obesity alone should not preclude LT, but recipients with obesity should be monitored for obesity‐related complications such as wound dehiscence and venous thrombosis.

Funder

National Institute on Aging

National Institute of Diabetes and Digestive and Kidney Diseases

Publisher

Wiley

Subject

Transplantation

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