Morbid obesity in liver transplant recipients adversely affects longterm graft and patient survival in a single‐institution analysis

Abstract

ObjectiveThe 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. MethodsA 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/m2, 18.0–24.9 kg/m2, 25.0–29.9 kg/m2, 30.0–35.0 kg/m2, 35.1–40.0 kg/m2 and >40 kg/m2, 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. ResultsA total of 785 patients met the study inclusion criteria. A BMI of >35 kg/m2 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/m2 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. ConclusionsObesity 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.