The impact of wait list body mass index changes on the outcome after liver transplantation

Orci, Lorenzo; Majno, Pietro; Berney, Thierry; Morel, Philippe; Mentha, Gilles; Toso, Christian

doi:10.1111/tri.12017

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Title		The impact of wait list body mass index changes on the outcome after liver transplantation
Authors		Orci, Lorenzo Majno, Pietro Berney, Thierry Morel, Philippe Mentha, Gilles Toso, Christian
Published in		Transplant International. 2013, vol. 26, no. 2, p. 170-6
Abstract		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.
Keywords		Adolescent — Adult — Aged — Body Mass Index — Body Weight — Female — Humans — Liver Failure/complications/therapy — Liver Transplantation/mortality — Male — Middle Aged — Obesity/complications — Overweight — Registries — Regression Analysis — Treatment Outcome — Young Adult
Identifiers		DOI: 10.1111/tri.12017 PMID: 23199077
Full text		Article (Published version) (130 Kb) - Limited access to UNIGE
Structures		Faculté de médecine / Section de médecine clinique / Département de chirurgie
Research groups		Chirurgie viscérale (104) Chirurgie viscérale (HUG) Hépatologie chirurgicale (327) Transplantation et hépatologie (905) La transplantation d'îlots de Langerhans (623)
Citation (ISO format)		ORCI, Lorenzo et al. The impact of wait list body mass index changes on the outcome after liver transplantation. In: Transplant International, 2013, vol. 26, n° 2, p. 170-6. doi: 10.1111/tri.12017 https://archive-ouverte.unige.ch/unige:29962