title: Impact of body mass index on outcomes of 48281 patients undergoing first time cadaveric liver transplantation.
abstract: OBJECTIVE
  To investigate possible disparities in perioperative morbidity and mortality among different body mass index (BMI) groups and to simulate the impact that these differences might have had on the cohort of patients undergoing cadaveric liver transplantation (LT).
  
  
  METHODS
  All adult recipients undergoing first time LT for benign conditions and receiving a whole graft from brain-dead donors were selected from the united network of organ sharing registry. From January 1994 to June 2013, 48281 patients satisfied the inclusion criteria and were stratified by their BMI. The hypothesis that abnormal BMIs were independent predictors of inferior outcomes was tested with univariate and multivariate regression analyses.
  
  
  RESULTS
  In comparison to normal weight recipients, underweight and morbidly obese recipients had increased 90-d mortality (adjusted OR = 1.737; 95%CI: 1.185-2.548, P = 0.005) (adjusted OR = 1.956; 95%CI: 1.473-2.597, P = 0.000) respectively and inferior patients' survivals (adjusted HR = 1.265; 95%CI: 1.096-1.461, P = 0.000) (adjusted HR = 1.157; 95%CI: 1.031-1.299, P = 0.013) respectively. Overall, patients' 5-year survival were 73.9% for normal-weight, 71.1% for underweight, 74.0% for overweight, 74.4% for class I obese, 75.0% for class II obese and 71.5% for class III obese recipients. Analysis of hypothetical exclusion of underweight and morbidly obese patients from the pool of potential LT candidates would have improved the overall survival of the entire cohort by 2.7% (95%CI: 2.5%-3.6%).
  
  
  CONCLUSIONS
  Selected morbidly obese patients undergoing LT for benign conditions had 5-year survival rates clinically comparable to normal weight recipients. Impact analysis showed that exclusion of high-risk recipients (underweight and morbid obese patients) would not significantly improve the overall survival of the entire cohort of patients requiring LT.
authors.affiliation: Subhashini Ayloo, Scott Hurton, Matthew Cwinn, Michele Molinari, Department of Surgery, Victoria General Hospital, Dalhousie University, Halifax, Nova Scotia B3H 2Y9, Canada.
authors.forename: Subhashini
authors.initials: S
authors.lastname: Ayloo
authors.affiliation: Subhashini Ayloo, Scott Hurton, Matthew Cwinn, Michele Molinari, Department of Surgery, Victoria General Hospital, Dalhousie University, Halifax, Nova Scotia B3H 2Y9, Canada.
authors.forename: Scott
authors.initials: S
authors.lastname: Hurton
authors.affiliation: Subhashini Ayloo, Scott Hurton, Matthew Cwinn, Michele Molinari, Department of Surgery, Victoria General Hospital, Dalhousie University, Halifax, Nova Scotia B3H 2Y9, Canada.
authors.forename: Matthew
authors.initials: M
authors.lastname: Cwinn
authors.affiliation: Subhashini Ayloo, Scott Hurton, Matthew Cwinn, Michele Molinari, Department of Surgery, Victoria General Hospital, Dalhousie University, Halifax, Nova Scotia B3H 2Y9, Canada.
authors.forename: Michele
authors.initials: M
authors.lastname: Molinari
keywords: Body mass index; Impact analysis; Liver transplantation; Obesity; Survival