The percentage of overweight and obese patients(OPs) waiting for a liver transplant continues to increase. Despite the significant advances occurred in bariatric medicine, obesity is still considered a relative contra...The percentage of overweight and obese patients(OPs) waiting for a liver transplant continues to increase. Despite the significant advances occurred in bariatric medicine, obesity is still considered a relative contraindication to liver transplantation(LT). The main aim of this review is to appraise the literature on the outcomes of OPs undergoing LT, treatments that might reduce their weight before, during or after surgery, and discuss some of the controversies and limitations of the current knowledge with the intent of highlighting areas where future research is needed.展开更多
AIM: To investigate possible disparities in perioperative morbidity and mortality among different body mass index(BMI) groups and to simulate the impact that these differences might have had on the cohort of patients ...AIM: To investigate possible disparities in perioperative morbidity and mortality among different body mass index(BMI) groups and to simulate the impact that these differences might have had on the cohort of patients undergoing cadaveric liver transplantation(LT).METHODS: All adult recipients undergoing first time LT for benign conditions and receiving a whole graft from brain-dead donors were selected from the united network of organ sharing registry. From January 1994 to June 2013, 48281 patients satisfied the inclusion criteria and were stratified by their BMI. The hypothesis that abnormal BMIs were independent predictors of inferior outcomes was tested with univariate and multivariate regression analyses.RESULTS: In comparison to normal weight recipients, underweight and morbidly obese recipients had increased 90-d mortality(adjusted OR = 1.737; 95%CI: 1.185-2.548, P = 0.005)(adjusted OR = 1.956; 95%CI: 1.473-2.597, P = 0.000) respectively and inferior patients' survivals(adjusted HR = 1.265; 95%CI: 1.096-1.461, P = 0.000)(adjusted HR = 1.157; 95%CI: 1.031-1.299, P = 0.013) respectively. Overall, patients' 5-year survival were 73.9% for normal-weight, 71.1% for underweight, 74.0% for overweight, 74.4% for class Ⅰ obese, 75.0% for class Ⅱ obese and 71.5% for class Ⅲ obese recipients. Analysis of hypothetical exclusion of underweight and morbidly obese patients from the pool of potential LT candidates would have improved the overall survival of the entire cohort by2.7%(95%CI: 2.5%-3.6%).CONCLUSION: Selected morbidly obese patients undergoing LT for benign conditions had 5-year survival rates clinically comparable to normal weight recipients. Impact analysis showed that exclusion of high-risk recipients(underweight and morbid obese patients) would not significantly improve the overall survival of the entire cohort of patients requiring LT.展开更多
文摘The percentage of overweight and obese patients(OPs) waiting for a liver transplant continues to increase. Despite the significant advances occurred in bariatric medicine, obesity is still considered a relative contraindication to liver transplantation(LT). The main aim of this review is to appraise the literature on the outcomes of OPs undergoing LT, treatments that might reduce their weight before, during or after surgery, and discuss some of the controversies and limitations of the current knowledge with the intent of highlighting areas where future research is needed.
文摘AIM: To investigate possible disparities in perioperative morbidity and mortality among different body mass index(BMI) groups and to simulate the impact that these differences might have had on the cohort of patients undergoing cadaveric liver transplantation(LT).METHODS: All adult recipients undergoing first time LT for benign conditions and receiving a whole graft from brain-dead donors were selected from the united network of organ sharing registry. From January 1994 to June 2013, 48281 patients satisfied the inclusion criteria and were stratified by their BMI. The hypothesis that abnormal BMIs were independent predictors of inferior outcomes was tested with univariate and multivariate regression analyses.RESULTS: In comparison to normal weight recipients, underweight and morbidly obese recipients had increased 90-d mortality(adjusted OR = 1.737; 95%CI: 1.185-2.548, P = 0.005)(adjusted OR = 1.956; 95%CI: 1.473-2.597, P = 0.000) respectively and inferior patients' survivals(adjusted HR = 1.265; 95%CI: 1.096-1.461, P = 0.000)(adjusted HR = 1.157; 95%CI: 1.031-1.299, P = 0.013) respectively. Overall, patients' 5-year survival were 73.9% for normal-weight, 71.1% for underweight, 74.0% for overweight, 74.4% for class Ⅰ obese, 75.0% for class Ⅱ obese and 71.5% for class Ⅲ obese recipients. Analysis of hypothetical exclusion of underweight and morbidly obese patients from the pool of potential LT candidates would have improved the overall survival of the entire cohort by2.7%(95%CI: 2.5%-3.6%).CONCLUSION: Selected morbidly obese patients undergoing LT for benign conditions had 5-year survival rates clinically comparable to normal weight recipients. Impact analysis showed that exclusion of high-risk recipients(underweight and morbid obese patients) would not significantly improve the overall survival of the entire cohort of patients requiring LT.
