title: Morbid obesity in liver transplant recipients adversely affects longterm graft and patient survival in a single-institution analysis.
abstract: OBJECTIVE
  The effects of obesity in liver transplantation remain controversial. Earlier institutional data demonstrated no significant difference in postoperative complications or 1-year mortality. This study was conducted to test the hypothesis that obesity alone has minimal effect on longterm graft and overall survival.
  
  
  METHODS
  A retrospective, single-institution analysis of outcomes in patients submitted to primary adult orthotopic liver transplantation was conducted using data for the period from 1 January 2002 to 31 December 2012. Recipients were divided into six groups by pre-transplant body mass index (BMI), comprising those with BMIs of <18.0 kg/m(2) , 18.0-24.9 kg/m(2) , 25.0-29.9 kg/m(2) , 30.0-35.0 kg/m(2) , 35.1-40.0 kg/m(2) and >40 kg/m(2) , respectively. Pre- and post-transplant parameters were compared. A P-value of <0.05 was considered to indicate statistical significance. Independent predictors of patient and graft survival were determined using multivariate analysis.
  
  
  RESULTS
  A total of 785 patients met the study inclusion criteria. A BMI of >35 kg/m(2) was associated with non-alcoholic steatohepatitis (NASH) cirrhosis (P < 0.0001), higher Model for End-stage Liver Disease (MELD) score, and longer wait times for transplant (P = 0.002). There were no differences in operative time, intensive care unit or hospital length of stay, or perioperative complications. Graft and patient survival at intervals up to 3 years were similar between groups. Compared with non-obese recipients, recipients with a BMI of >40 kg/m(2) showed significantly reduced 5-year graft (49.0% versus 75.8%; P < 0.02) and patient (51.3% versus 78.8%; P < 0.01) survival.
  
  
  CONCLUSIONS
  Obesity increasingly impacts outcomes in liver transplantation. Although the present data are limited by the fact that they were sourced from a single institution, they suggest that morbid obesity adversely affects longterm outcomes despite providing similar short-term results. Further analysis is indicated to identify risk factors for poor outcomes in morbidly obese patients.
authors.affiliation: Section of Abdominal Transplantation, Department of Surgery, School of Medicine, Washington University in St Louis, St Louis, MO, USA.
authors.forename: Kendra D
authors.initials: KD
authors.lastname: Conzen
authors.forename: Neeta
authors.initials: N
authors.lastname: Vachharajani
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Collins
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Anderson
authors.forename: Yiing
authors.initials: Y
authors.lastname: Lin
authors.forename: Jason R
authors.initials: JR
authors.lastname: Wellen
authors.forename: Surendra
authors.initials: S
authors.lastname: Shenoy
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Lowell
authors.forename: M B Majella
authors.initials: MB
authors.lastname: Doyle
authors.forename: William C
authors.initials: WC
authors.lastname: Chapman
mesh_terms: D000328:Adult; D015992:Body Mass Index; D015331:Cohort Studies; D058625:End Stage Liver Disease / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006785:Hospitals, University; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications / Q000401:mortality* / Q000503:physiopathology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D066027:Transplant Recipients / Q000706:statistics & numerical data*; D016896:Treatment Outcome