title: Obesity portends increased morbidity and earlier recurrence following liver transplantation for hepatocellular carcinoma.
abstract: BACKGROUND
  Obesity has been associated with poor oncologic outcomes following pancreatoduodenectomy for pancreatic cancer. However, there is a paucity of evidence on the impact of obesity on postoperative complications, oncologic outcome and survival in patients with hepatocellular carcinoma (HCC) undergoing orthotopic liver transplantation (OLT).
  
  
  METHODS
  From a database of over 1000 patients who underwent OLT during 1996-2008, 159 patients with a diagnosis of HCC were identified. Demographic data, body mass index (BMI), perioperative parameters, recurrence and survival were obtained. Complications were grouped according to Clavien-Dindo grading (Grades I-V).
  
  
  RESULTS
  There were increased incidences of life-threatening complications in overweight (58%) and obese (70%) patients compared with the non-obese patient group (41%) (P < 0.05). Furthermore, the incidence of recurrence of HCC was doubled in the presence of overweight (15%) and obesity (15%) compared with non-obesity (7%) (P < 0.05). Time to recurrence also decreased significantly. Differences in mean ± standard deviation survival in the overweight (45 ± 3 months) and obese (41 ± 4 months) groups compared with the non-obese group (58 ± 6 months) did not reach statistical significance.
  
  
  CONCLUSIONS
  These findings indicate that BMI is an important surrogate marker for obesity and portends an increased risk for complications and a poorer oncologic outcome following OLT for HCC.
authors.affiliation: Department of Surgery, University of South Florida, Tampa, FL 33606, USA.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Mathur
authors.forename: Edson S
authors.initials: ES
authors.lastname: Franco
authors.forename: John P
authors.initials: JP
authors.lastname: Leone
authors.forename: Hussein
authors.initials: H
authors.lastname: Osman-Mohamed
authors.forename: Haydy
authors.initials: H
authors.lastname: Rojas
authors.forename: Nyingi
authors.initials: N
authors.lastname: Kemmer
authors.forename: Guy W
authors.initials: GW
authors.lastname: Neff
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Rosemurgy
authors.forename: Angel E
authors.initials: AE
authors.lastname: Alsina
mesh_terms: D000704:Analysis of Variance; D015992:Body Mass Index; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008113:Liver Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D009765:Obesity / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome