title: Nutritional status of patients with alcoholic cirrhosis undergoing liver transplantation: time trends and impact on survival.
abstract: Alcoholic cirrhotics evaluated for liver transplantation are frequently malnourished or obese. We analyzed alcoholic cirrhotics undergoing transplantation to examine time trends of nutrition/weight, transplant outcome, and effects of concomitant hepatitis C virus (HCV) and/or hepatocellular carcinoma (HCC). Nutrition and transplant outcomes were reviewed for alcoholic cirrhosis with/without HCV/HCC. Malnutrition was defined by subjective global assessment. Body mass index (BMI) classified obesity. A total of 261 patients receiving transplants were separated (1988-2000, 2001-2006, and 2007-2011) to generate similar size cohorts. Mean BMI for the whole cohort was 28 ± 6 with 68% classified as overweight/obese. Mean BMI did not vary among cohorts and was not affected by HCV/HCC. While prevalence of malnutrition did not vary among cohorts, it was lower in patients with HCV/HCC (P < 0.01). One-year graft/patient survival was 90% and not impacted by time period, HCV/HCC, or malnutrition after adjusting for demographics and model end-stage liver disease (MELD). Alcoholic cirrhotics undergoing transplantation are malnourished yet frequently overweight/obese. Among patients selected for transplantation, 1-year post-transplant graft/patient survival is excellent, have not changed over time, and do not vary by nutrition/BMI. Our findings support feasibility of liver transplantation for alcoholic cirrhotics with obesity and malnutrition.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Ashwani K
authors.initials: AK
authors.lastname: Singal
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Kamath
authors.forename: Nickie
authors.initials: N
authors.lastname: Francisco Ziller
authors.forename: Sara
authors.initials: S
authors.lastname: DiCecco
authors.forename: M
authors.initials: M
authors.lastname: Shoreibah
authors.forename: Walter
authors.initials: W
authors.lastname: Kremers
authors.forename: Michael R
authors.initials: MR
authors.lastname: Charlton
authors.forename: Julie K
authors.initials: JK
authors.lastname: Heimbach
authors.forename: Kymberly D
authors.initials: KD
authors.lastname: Watt
authors.forename: Vijay H
authors.initials: VH
authors.lastname: Shah
mesh_terms: D015992:Body Mass Index; D006528:Carcinoma, Hepatocellular / Q000150:complications*; D005260:Female; D006085:Graft Survival; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications* / Q000601:surgery*; D008113:Liver Neoplasms / Q000150:complications; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D044342:Malnutrition / Q000150:complications*; D008875:Middle Aged; D009752:Nutritional Status; D009765:Obesity / Q000150:complications
keywords: alcoholic liver disease; hepatitis C virus; hepatocellular carcinoma; malnutrition; mortality; orthotopic liver transplantation