The impact of obesity on long-term outcomes in liver transplant recipients-results of the NIDDK liver transplant database

被引:175
作者
Leonard, J. [1 ]
Heimbach, J. K. [2 ]
Malinchoc, M. [3 ]
Watt, K. [1 ]
Charlton, M. [1 ]
机构
[1] Mayo Clin & Mayo Fdn, Div Gastroenterol & Hepatol, Rochester, MN 55905 USA
[2] Mayo Clin & Mayo Fdn, Dept Surg, Rochester, MN 55905 USA
[3] Mayo Clin & Mayo Fdn, Dept Biostat, Rochester, MN 55905 USA
关键词
liver transplantation; obesity; outcomes research;
D O I
10.1111/j.1600-6143.2007.02100.x
中图分类号
R61 [外科手术学];
学科分类号
摘要
The impact of obesity on outcomes following liver transplantation has been difficult to determine, in part due to the confounding effects of ascites on BMI. We evaluated the impact of pretransplant recipient obesity on outcomes following liver transplantation using the NIDDK Liver Transplantation Database. Pretransplant BMI, corrected for ascites, was categorized as underweight (BMI < 18 kg/m(2)), normal weight (BMI 18-25 kg/m(2)), overweight (BMI 25.1-30 kg/m(2)), Class I obese (BMI 30.1-35 kg/m(2)), Class II obese (BMI 35.1-40 kg/m(2)) and Class III obese (BMI > 40 kg/m(2)). Primary outcomes were patient and graft survival. Secondary outcomes included days in hospital and days in ICU. Data from 704 adult liver transplant recipients from the NIDDK LTD and a further 609 patients from the Mayo Clinic were analyzed. Early and late patient and graft survival was similar across all BMI categories. Correcting for ascites volume resulted in 11-20% of patients moving into a lower BMI classification. The relative risk for mortality increased by 7% for each liter of ascites removed. We conclude that corrected BMI is not independently predictive of patient or graft survival. Obesity, within the ranges observed in this study, should not be considered to be a contraindication to liver transplantation in the absence of other relative contraindications.
引用
收藏
页码:667 / 672
页数:6
相关论文
共 15 条
[1]   Nonalcoholic fatty liver disease and liver transplantation [J].
Angulo, P .
LIVER TRANSPLANTATION, 2006, 12 (04) :523-534
[2]   Nonalcoholic fatty liver disease [J].
Brunt, Elizabeth M. ;
Wong, Vincent W. -S. ;
Nobili, Valerio ;
Day, Christopher P. ;
Sookoian, Silvia ;
Maher, Jacquelyn J. ;
Bugianesi, Elisabetta ;
Sirlin, Claude B. ;
Neuschwander-Tetri, BrentA. ;
Rinella, Mary E. .
NATURE REVIEWS DISEASE PRIMERS, 2015, 1
[3]   Liver transplantation in the morbidly obese [J].
Braunfeld, MY ;
Chan, S ;
Pregler, J ;
Neelakanta, G ;
Sopher, MJ ;
Busuttil, RW ;
Csete, M .
JOURNAL OF CLINICAL ANESTHESIA, 1996, 8 (07) :585-590
[4]   Nonalcoholic Fatty Liver Disease: A Review of Current Understanding and Future Impact [J].
Charlton, Michael .
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY, 2004, 2 (12) :1048-1058
[5]   The impact of obesity on surgical outcomes: A review [J].
Choban, PS ;
Flancbaum, L .
JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 1997, 185 (06) :593-603
[6]  
Flancbaum L, 1998, ANNU REV MED, V49, P215
[7]   Clinical and financial impact of obesity on the outcome of liver transplantation [J].
Fujikawa, T. ;
Fujita, S. ;
Mizuno, S. ;
Shenkman, E. ;
Vogel, B. ;
Lipori, P. ;
Hemming, A. W. ;
Nelson, D. ;
Reed, A. I. .
TRANSPLANTATION PROCEEDINGS, 2006, 38 (10) :3612-3614
[8]   Obesity increases mortality in liver transplantation - the Danish experience [J].
Hillingso, JG ;
Wettergren, A ;
Hyoudo, M ;
Kirkegaard, P .
TRANSPLANT INTERNATIONAL, 2005, 18 (11) :1231-1235
[9]  
KEEFFE EB, 1994, TRANSPLANTATION, V57, P309
[10]   Obesity and its effect on survival in patients undergoing orthotopic liver transplantation in the United States [J].
Nair, S ;
Verma, S ;
Thuluvath, PJ .
HEPATOLOGY, 2002, 35 (01) :105-109