Sa1011 Obesity Is Associated With Significantly Lower Long-Term Survival Among Patients With Acute Liver Failure Undergoing Liver Transplantation in the United States

Abstract

Background: Over 2,000 cases of acute liver failure (ALF) are reported in the U.S. on an annual basis. Previous studies have demonstrated that the prevalence of obesity in patients with ALF is comparable to general U.S. population. However, obese patients that developed ALF had significantly poorer survival. The validity of these studies was limited by the fact that body mass index (BMI) data was missing in over 25% of ALF patients. Our study aims to evaluate the impact of obesity on post-liver transplantation (LT) survival among ALF patients in the U.S. Methods: Adult patients with ALF undergoing LT in the U.S. from 20032012 were evaluated using data from the United Network for Organ Sharing registry. Patient demographics and clinical characteristics (including the etiology of ALF) were evaluated using chi square testing for categorical variables and Student's t-test for continuous variables. Non-parametric methods were used for non-normally distributed variables. Analyses were stratified by obesity status (BMI > 30 kg/m2) and race/ethnicity. Overall long term post-LT survival was evaluated with KaplanMeier methods and multivariate Cox proportional hazards models (adjusted for age, sex, race/ethnicity, etiology of ALF, obesity, year of LT, MELD score, ascites and presence of diabetes). Results: A total of 2,924 patients with ALF underwent LT from 2003-2012. Overall, 31.8% of ALF patients undergoing LT were obese (mean BMI: 27.1 ± 6.1) and 9.2% (n=246) had diabetes. When stratified by race/ethnicity, blacks had the highest rates of obesity (44.0%, n=210), followed by non-Hispanic whites (30.4%, n= 556), Hispanics (30.3%, n=100), and Asians (17.5%, n=43), p<0.001. Compared to nonobese patients, there was a trend towards lower 5-year post-LT survival among obese ALF patients (73.4% vs. 76.0%, p=0.18). However, when compared with non-obese, non-diabetic patients, there was a stronger trend towards lower post-LT survival among obese diabetic ALF patients (66.9% vs. 77.3%, p=0.08). In the multivariate Cox proportional hazards model, obesity was independently associated with lower post-LT survival in ALF patients (HR 1.20, 95% CI 1.00-1.43, p<0.01) (Table). Presence of diabetes was also associated with significantly lower post-LT survival (HR 1.45, 95% CI 1.09-1.93, p=0.01). Conclusions: Among patients with ALF undergoing LT, obesity is associated with significantly lower post-LT survival. Concurrent diabetes among obese ALF patients may confer an additional survival disadvantage. Multivariate Cox Proportional Hazards Model