Additive effect of pretransplant obesity, diabetes, and cardiovascular risk factors on outcomes after liver transplantation

The effects of pretransplant obesity, diabetes mellitus (DM), coronary artery disease (CAD), and hypertension (HTN) on outcomes after liver transplantation (LT) are controversial. Questions have also been raised about the appropriateness of the body mass index (BMI) for assessing obesity in patients...

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Bibliographic Details
Published in:Liver transplantation 2014-03, Vol.20 (3), p.281-290
Main Authors: Dare, Anna J., Plank, Lindsay D., Phillips, Anthony R. J., Gane, Edward J., Harrison, Barry, Orr, David, Jiang, Yannan, Bartlett, Adam S. J. R.
Format: Article
Language:English
Subjects:
Adult
Aged
Body Mass Index
Cardiovascular Diseases - complications
Diabetes Complications
End Stage Liver Disease - complications
End Stage Liver Disease - mortality
End Stage Liver Disease - surgery
Female
Fibrosis - complications
Fibrosis - surgery
Hepatitis C - complications
Hepatitis C - surgery
Humans
Length of Stay
Liver Transplantation
Male
Middle Aged
New Zealand
Obesity - complications
Retrospective Studies
Risk Factors
Treatment Outcome
Young Adult
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Summary:The effects of pretransplant obesity, diabetes mellitus (DM), coronary artery disease (CAD), and hypertension (HTN) on outcomes after liver transplantation (LT) are controversial. Questions have also been raised about the appropriateness of the body mass index (BMI) for assessing obesity in patients with end‐stage liver disease. Both issues have implications for organ allocation in LT. To address these questions, we undertook a cohort study of 202 consecutive patients (2000‐2010) undergoing LT at a national center in New Zealand. BMI and body fat percentage (%BF) values (dual‐energy X‐ray absorptiometry) were measured before transplantation, and the methods were compared. The influence of pretransplant risk variables (including obesity, DM, CAD, and HTN) on the 30‐day postoperative event rate, length of hospital stay, and survival were analyzed. There was agreement between the calculated BMI and the measured %BF for 86.0% of the study population (κ coefficient = 0.73, 95% confidence interval = 0.61‐0.85), and this was maintained across increasing Model for End‐Stage Liver Disease scores. Obesity was an independent risk factor for the postoperative event rate [count ratio (CR) = 1.03, P 
ISSN:1527-6465
1527-6473
DOI:10.1002/lt.23818