Post-transplant obesity impacts long-term survival after liver transplantationvan Son, J., Stam, S. P., Gomes-Neto, A. W., Osté, M. C. J., Blokzijl, H., van den Berg, A. P., Porte, R. J., Bakker, S. J. L. & de Meijer, V. E., May-2020, In : Metabolism: Clinical and Experimental. 106, 9 p., 154204.
Research output: Contribution to journal › Article › Academic › peer-review
Background: Short-term survival after orthotopic liver transplantation (OLT) has improved over the past decades, but long-term survival remains impaired. The effects of obesity on long-term survival after OLT are controversial. Because pre-transplant body mass index (BMI) can be confounded by ascites, we hypothesized that post-transplant BMI at 1 year could predict long-term survival. Methods: A post-hoc analysis was performed of an observational cohort study consisting of adult recipients of a first OLT between 1993 and 2010. Baseline BMI was measured at 1-year post-transplantation to represent a stable condition. Recipients were stratified into normal weight (BMI < 25 kg/m2), overweight (25 ≤ BMI ≤ 30 kg/m2), and obese (BMI > 30 kg/m2). Kaplan-Meier survival analyses were performed with log-rank testing, followed by multivariable Cox proportional hazards regression analysis. Results: Out of 370 included recipients, 184 had normal weight, 136 were overweight, and 50 were obese at 1-year post-transplantation. After median follow-up for 12.3 years, 107 recipients had died, of whom 46 (25%) had normal weight, 39 (29%) were overweight, and 22 (44%) were obese (log-rank P = 0.020). Obese recipients had a significantly increased mortality risk compared to normal weight recipients (HR 2.00, 95% CI 1.08–3.68, P = 0.027). BMI was inversely associated with 15 years patient survival (HR 1.08, 95% CI 1.03–1.14, P = 0.001 per kg/m2), independent of age, gender, muscle mass, transplant characteristics, cardiovascular risk factors, kidney- and liver function. Conclusion: Obesity at 1-year post-transplantation conveys a 2-fold increased mortality risk, which may offer potential for interventional strategies (i.e. dietary advice, lifestyle modification, or bariatric surgery) to improve long-term survival after OLT.
|Number of pages||9|
|Journal||Metabolism: Clinical and Experimental|
|Early online date||2020|
|Publication status||Published - May-2020|
- Liver transplantation, Body mass index, Long-term, Survival, Obesity, SINGLE-CENTER EXPERIENCE, BODY-MASS INDEX, MYCOPHENOLATE-MOFETIL, METABOLIC SYNDROME, DIABETES-MELLITUS, RENAL DYSFUNCTION, PATIENT SURVIVAL, RISK-FACTORS, WEIGHT-GAIN, RECIPIENTS