title: Additive impact of pre-liver transplant metabolic factors on survival post-liver transplant.
abstract: OBJECTIVE
  Diabetes at time of liver transplantation is associated with reduced post-transplant survival. We aimed to assess whether additional metabolic conditions such as obesity or hypertension had additive prognostic impact on post-transplantation survival.
  
  
  METHODS
  A multi-center cohort study of 617 adult subjects undergoing liver transplantation between 2003 and 2009 has been used. Dry body mass index was calculated following adjustment for ascites.
  
  
  RESULTS
  After a median follow-up of 5.8 years (range 0-10.5), 112 (18.2%) patients died. Diabetes was associated with reduced post-transplant survival (hazard ratio 1.89, 95% confidence interval [CI] 1.25-2.86, P = 0.003), whereas obesity, hypertension, dyslipidemia, and the metabolic syndrome itself were not (P > 0.3 for all). Patients with concomitant diabetes and obesity had lower survival (adjusted Hazard Ratio [aHR] 2.40, 95%CI 1.32-4.38, P = 0.004), whereas obese non-diabetic patients or diabetic non-obese patients had similar survival compared with non-diabetic, non-obese individuals. The presence of hypertension or dyslipidemia did not impact on survival in patients with diabetes (P > 0.1 for both). Obese diabetic patients had longer intensive care and hospital stays than non-obese diabetic or obese, non-diabetic patients (P < 0.05). The impact of concomitant obesity and diabetes on survival was greater in subjects aged 50+ years (52.6% 5-year survival, aHR 3.04, 95% CI 1.54-5.98) or those transplanted with hepatocellular carcinoma (34.1% 5-year survival, aHR 3.35, 95% CI 1.31-5.57). Diabetes without obesity was not associated with an increased mortality rate in these sub-groups.
  
  
  CONCLUSIONS
  Concomitant diabetes and obesity but not each condition in the absence of the other is associated with reduced post-liver transplant survival. The impact of diabetes and obesity is greater in older patients and those with hepatocellular carcinoma.
authors.affiliation: Sir Charles Gairdner Hospital, Perth, Australia.|School of Medicine and Pharmacology, The University of Western Australia, Perth, Western Australia.
authors.forename: Leon A
authors.initials: LA
authors.lastname: Adams
authors.affiliation: Sir Charles Gairdner Hospital, Perth, Australia.
authors.forename: Oscar
authors.initials: O
authors.lastname: Arauz
authors.affiliation: The Austin Hospital, Melbourne, Victoria, South Australia.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Angus
authors.affiliation: The Austin Hospital, Melbourne, Victoria, South Australia.
authors.forename: Marie
authors.initials: M
authors.lastname: Sinclair
authors.affiliation: Princess Alexandra Hospital, Brisbane, Queensland, South Australia.
authors.forename: Graeme A
authors.initials: GA
authors.lastname: MacDonald
authors.affiliation: Princess Alexandra Hospital, Brisbane, Queensland, South Australia.
authors.forename: Utti
authors.initials: U
authors.lastname: Chelvaratnam
authors.affiliation: Flinders Medical Centre, Adelaide, South Australia.
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Wigg
authors.affiliation: Flinders Medical Centre, Adelaide, South Australia.
authors.forename: Sze
authors.initials: S
authors.lastname: Yeap
authors.affiliation: Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Shackel
authors.affiliation: Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
authors.forename: Linda
authors.initials: L
authors.lastname: Lin
authors.affiliation: Sir Charles Gairdner Hospital, Perth, Australia.
authors.forename: Spiro
authors.initials: S
authors.lastname: Raftopoulos
authors.affiliation: Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
authors.forename: Geoffrey W
authors.initials: GW
authors.lastname: McCaughan
authors.affiliation: Sir Charles Gairdner Hospital, Perth, Australia.|School of Medicine and Pharmacology, The University of Western Australia, Perth, Western Australia.
authors.forename: Gary P
authors.initials: GP
authors.lastname: Jeffrey
mesh_terms: D000328:Adult; D000367:Age Factors; D001315:Australia; D015415:Biomarkers / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis / Q000401:mortality*; D050171:Dyslipidemias / Q000401:mortality; D005260:Female; D006801:Humans; D006973:Hypertension / Q000401:mortality; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality*; D008297:Male; D024821:Metabolic Syndrome / Q000401:mortality; D008875:Middle Aged; D009765:Obesity / Q000175:diagnosis / Q000401:mortality*; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers
keywords: diabetes; liver transplantation; obesity