Tipping the Scales: Liver Transplant Outcomes of the Super Obese.
We aim to study outcomes in liver transplant recipients with body mass index (BMI) ≥50 using the United Network for Organ Sharing (UNOS) database.



We reviewed patients undergoing liver transplantation recorded in the UNOS database from 1988 to 2013. Of 104,250 liver transplant procedures, 123 were performed on super obese patients.



Sixty-four percent of the super obese patients are female (64 %) and had a mean age 47 years (20-71). The mean BMI was 53.5 (50-72.86) and 16 % had diabetes. The mean Model for End-Stage Disease (MELD) score at transplant was 29.1 (6-53). It was found that BMI ≥50 increased 1.6-fold the risk of death within 30 days after liver transplantation. Graft failure was increased by 52 % and overall mortality was by 62 %. A 1:1 propensity score-matched analysis demonstrated that patients with BMI <50 have significantly better graft and overall patient survival than the super obese.



Overall, our data shows that BMI ≥50 is an independent predictor of perioperative mortality and graft and overall patient survival. Further studies are necessary to better understand predictors of outcomes in super obese patients.
Department of Surgery, University of Kentucky College of Medicine Transplant Center, 800 Rose Street, C451, Lexington, KY, 40536-0293, USA.
Jose
J
Alvarez
Department of Surgery, University of Kentucky College of Medicine Transplant Center, 800 Rose Street, C451, Lexington, KY, 40536-0293, USA.
Xioanon
X
Mei
Department of Surgery, University of Kentucky College of Medicine Transplant Center, 800 Rose Street, C451, Lexington, KY, 40536-0293, USA.
Michael
M
Daily
Department of Surgery, University of Kentucky College of Medicine Transplant Center, 800 Rose Street, C451, Lexington, KY, 40536-0293, USA.
Malay
M
Shah
Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Kentucky College of Medicine, Lexington, KY, USA.
Alla
A
Grigorian
Department of Surgery, University of Kentucky College of Medicine Transplant Center, 800 Rose Street, C451, Lexington, KY, 40536-0293, USA.
Jonathan
J
Berger
Department of Surgery, University of Kentucky College of Medicine Transplant Center, 800 Rose Street, C451, Lexington, KY, 40536-0293, USA.
Francesc
F
Marti
Department of Surgery, University of Kentucky College of Medicine Transplant Center, 800 Rose Street, C451, Lexington, KY, 40536-0293, USA. rgeda2@uky.edu.
Roberto
R
Gedaly
D000328:Adult; D000368:Aged; D015992:Body Mass Index; D058625:End Stage Liver Disease / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications*; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
Liver transplantation; Outcomes; Super obesity