title: Impact of obesity and diabetes on waitlist survival, probability of liver transplantation and post-transplant survival among chronic hepatitis C virus patients.
abstract: The rising prevalence of obesity and diabetes mellitus (DM) among hepatitis C virus (HCV) patients contributes to concurrent nonalcoholic fatty liver disease (NAFLD). We aim to evaluate the impact of concurrent obesity or DM on waitlist survival and probability of liver transplantation (LT) among adults with chronic HCV awaiting LT.
  
  
  
  Using 2003-2013 United Network for Organ Sharing data, we evaluated the impact of obesity and DM among adults with chronic HCV awaiting LT: non-obese, non-DM vs. obese, non-DM (obese) vs. non-obese, DM (DM) vs. obese and DM. Overall, LT waitlist survival and probability of receiving LT were evaluated using Kaplan-Meier and multivariate logistic regression models.
  
  
  
  From 2003-2013, there were 43 478 new LT waitlist registrants with chronic HCV (21.0% with HCC, 79% without HCC). Obesity was associated with lower probability of receiving LT (OR, 0.91; 95% CI, 0.85-0.97; P < 0.01), and lower probability of waitlist mortality (OR, 0.80; 95% CI, 0.72-0.89; P < 0.001) when compared to non-obese patients. DM among HCV patients did not impact probability of waitlist survival or receiving LT. When evaluating post-LT survival, compared to non-obese, non-DM patients, obese HCV patients had significantly lower post-LT mortality (HR 0.86; 95%CI, 0.81-0.92; P < 0.001); whereas, HCV patients with DM had significantly higher post-LT mortality (HR, 1.22; 95% CI, 1.12-1.33; P < 0.001).
  
  
  
  Among adults with chronic HCV awaiting LT in the US, obesity is associated with lower probability of receiving LT, but did not impact waitlist survival. DM among chronic HCV patients did not impact waitlist survival or probability of LT.
authors: Department of Medicine, Alameda Health System - Highland Hospital, Oakland, CA, USA.
authors: Maria
authors: M
authors: Aguilar
authors: Division of Gastroenterology and Hepatology, Alameda Health System - Highland Hospital, Oakland, CA, USA.
authors: Benny
authors: B
authors: Liu
authors: Department of Transplantation, Division of Hepatology, California Pacific Medical Center, San Francisco, CA, USA.
authors: Edward W
authors: EW
authors: Holt
authors: Division of Gastroenterology and Hepatology, Alameda Health System - Highland Hospital, Oakland, CA, USA.
authors: Taft
authors: T
authors: Bhuket
authors: Division of Gastroenterology and Hepatology, Alameda Health System - Highland Hospital, Oakland, CA, USA.
authors: Robert J
authors: RJ
authors: Wong
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000453:epidemiology; D048909:Diabetes Complications / Q000453:epidemiology*; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D008113:Liver Neoplasms / Q000453:epidemiology; D016031:Liver Transplantation; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications*; D009765:Obesity / Q000453:epidemiology*; D012307:Risk Factors; D016019:Survival Analysis; D014481:United States; D014850:Waiting Lists / Q000401:mortality*
keywords: HCV; United Network for Organ Sharing; fatty liver; hepatocellular carcinoma; nonalcoholic fatty liver disease