title: The impact of obesity as determined by modified body mass index on long-term outcome after liver transplantation: Canadian single-center experience.
abstract: BACKGROUND
  Obesity is thought to be associated with higher rates of morbidity and mortality after liver transplantation (LT); however, its actual impact is difficult to evaluate, in part because of the confounding effects of fluid accumulation on body mass index (BMI).
  
  
  OBJECTIVE
  We sought to define the effects of conventional BMI (cBMI) and modified BMI (mBMI; calculated by multiplying the BMI by serum albumin level to compensate for fluid accumulation), on the outcome of LT recipients overall.
  
  
  METHODS
  A cohort of 507 patients who underwent LT from April 2000 to August 2006 were analyzed.
  
  
  RESULTS
  Pre-LT diabetes mellitus was seen somewhat more frequently in the higher mBMI group (P = .054), whereas there was no difference across cBMI categories. The recipients at extremes of cBMI (>40 kg/m(2) and <18.5 kg/m(2)) had significantly lower patient and graft survival than other groups (P = .038 and P = .010, respectively); however, no statistically significant differences were found in overall patient and graft survival across mBMI categories. There were no differences in duration of intensive care unit stay, duration of overall hospital stay, and vascular complications after LT among mBMI categories.
  
  
  CONCLUSIONS
  Pre-LT obesity alone, when estimated by mBMI rather than by cBMI, should not be a contraindication for LT.
authors: Multi-Organ Transplant Program/Liver Transplant Unit, University Health Network/Toronto General Hospital, Toronto, Ontario, Canada.
authors: T
authors: T
authors: Tanaka
authors: E L
authors: EL
authors: Renner
authors: N
authors: N
authors: Selzner
authors: G
authors: G
authors: Therapondos
authors: L B
authors: LB
authors: Lilly
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D000075202:Contraindications; D005260:Female; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D016031:Liver Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D009864:Ontario; D018579:Patient Selection; D011183:Postoperative Complications / Q000401:mortality; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D000075462:Serum Albumin, Human; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: C422455:ALB protein, human; D015415:Biomarkers; D012709:Serum Albumin; D000075462:Serum Albumin, Human