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Researchers find morbid obesity not linked to death after transplantation
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SAN FRANCISCO — Patients with morbid obesity do not have inferior outcomes after liver transplantation compared with lower weight transplant recipients, but they do have an increased risk of dying on the wait list before receiving liver transplantation, according to data presented at The Liver Meeting 2015.
“Our study revealed that obese patients benefit more from liver transplantation than lower weight patients, and suggests that we should consider lowering weight restrictions for patients who are otherwise good candidates for liver transplant,” Barry Schlansky, MD, MPH, said in a press release.
Barry Schlansky
Schlansky and colleagues evaluated patients waitlisted for liver transplant (LT) between 2005 and 2014 (n = 80,221) enrolled in the national United Network for Organ Sharing transplant database. Patients were classified as normal/overweight, obese, severely obese, and morbidly obese, and were followed for outcomes from the time of wait listing and from the time of liver transplantation.
Overall, 3.9% of the waitlisted patients were morbidly obese, as well as 3.5% of 38,177 patients who underwent LT.
In multiple regression analysis, wait list mortality was higher in patients who were morbidly obese (subhazard ratio 1.16). However, post-transplant mortality and graft failure did not differ according to body weight. In an analysis of transplant survival benefit, morbidly obese patients were also found to benefit more from liver transplantation than lower weight patients.
Further analysis showed that prior to 2007, morbid obesity was associated with higher post-transplant mortality (adjusted HR = 1.18), but since 2007, post-transplant mortality was the same regardless of body weight (adjusted HR = 0.95), suggesting that outcomes after transplant for obese patients have improved over time.
“Most U.S. liver transplant centers follow general recommendations that recommend against transplanting very obese patients. We hope our research will open the possibility for centers to consider liver transplantation for very obese patients who are otherwise good candidates,” Schlansky said.
The researchers concluded: “Morbid obesity. … should not be viewed as an LT contra-indication. Higher waitlist mortality and greater survival benefit in the morbidly obese indicate a disadvantage in access to LT relative to lower weight patients.”
Reference:
Schlansky B, et al. Abstract 69. Presented at: The Liver Meeting; Nov. 13-17, 2015; San Francisco.
Disclosures: The researchers report no relevant financial disclosures.
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Gyongyi Szabo, MD, PhD, FAASLD
This is an abstract that raises some interesting questions such as are we disadvantaging the morbidly obese. As you know, the increased prevalence of obesity is certainly an issue for many transplant centers.
So here, [researchers] looked at patients who had BMI that was greater than 40 compared to other patients. What they found was that morbidly obese patients had increased risk of death while on the liver transplant wait list, but when they compared the risk of death after transplantation, the risk of death after transplantation between the morbidly obese and other control population was very much the same.
Calculations were made in this particular presentation [stating that] there indeed is survival benefit in liver transplantation with increases in the body mass index.
The authors concluded that morbidly obese patients no longer have inferior post-transplant outcomes and raise the benefits of liver transplantation in morbidly obese patients.
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