title: The impact of obesity on patient survival in liver transplant recipients: a meta-analysis.
abstract: OBJECTIVE
  It is controversial if obesity has an impact on overall survival after liver transplantation (LT). The goal of this study was to determine if obesity impacts liver transplant recipient survival. Through subgroup analysis, we also evaluated different body mass index (BMI) thresholds and the confounding effect of ascites on survival.
  
  
  METHODS
  A systematic literature search from 1990 until July 2013. The main outcome was to evaluate the impact of obesity on survival in adult LT recipients. Dochotomous outcomes were reported as relative risk (RR) with 95% confidence intervals (CI).
  
  
  RESULTS
  Thirteen studies with a total 2275 obese and 72 212 non obese patients were included in the analysis. The combined analysis showed no difference in mortality between control and increased weight patients (RR = 0.97, 95% CI [0.82, 1.13], P = 0.66) at last follow-up. Moreover, no differences in mortality were noted in subgroup analysis comparing different BMI thresholds. There was also no differences in survival when BMI was adjusted for ascites or in studies where the liver disease severity was similar. Obese patients had worse survival than nonobese patients in pooled analysis of studies which had similar causes of liver disease (RR = 0.69, 95% CI [0.52, 0.92], P = 0.01).
  
  
  CONCLUSIONS
  The results of our pools analysis suggest that BMI does not specifically impact patient survival. However, obese patients have worse survival when analysis was performed in studies whose cohorts of obese and nonobese patients had similar causes of liver disease.
authors: Department of Surgery, University of California at Los Angeles, Los Angeles, CA, USA; Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.
authors: Sammy
authors: S
authors: Saab
authors: David
authors: D
authors: Lalezari
authors: Paridhima
authors: P
authors: Pruthi
authors: Theodore
authors: T
authors: Alper
authors: Myron J
authors: MJ
authors: Tong
mesh_terms: D000328:Adult; D001201:Ascites / Q000473:pathology; D015992:Body Mass Index; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality*; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D012306:Risk; D016019:Survival Analysis; D066027:Transplant Recipients / Q000706:statistics & numerical data*
keywords: liver transplantation; obesity