5 years ago

Weighing the risks: Morbid obesity and diabetes are associated with increased risk of death on the liver transplant waiting list

Jennifer L. Dodge, Danielle Brandman, Ani A. Kardashian, John Roberts
Background & Aims Obesity is a growing problem in liver transplant (LT) candidates, paralleling the US obesity epidemic and increase in LT for non-alcoholic steatohepatitis (NASH). While post-LT survival appears to be similar in obese and non-obese patients, data are scarce regarding risk of waitlist dropout in patients with morbid obesity (BMI ≥ 40 kg/m2). We examined the impact of obesity on waitlist mortality and evaluated predictors of dropout in LT candidates with morbid obesity or NASH. Methods Competing risk analyses were performed in candidates listed between 3/2002-12/2013 to evaluate predictors of waitlist removal or death. Variables with P-value <.05 in univariable models or clinically relevant were included in multivariable models. Results Eighty-four thousand two hundred and fifty-four patients (34% female, median age 55, 15% Hispanic) were included. Compared to those with BMI 25-29.9 kg/m2, candidates with BMI ≥ 40 kg/m2 were more likely to be female (46% vs 28%), diabetic (25% vs 18%) and have NASH (35% vs 13%); all P < .001. After adjusting for well-recognized predictors of waitlist dropout, including ascites severity, morbid obesity (HR = 1.27, CI 1.20-1.36) and diabetes (HR = 1.14, CI 1.11-1.17) were independent predictors of dropout. Morbid obesity remained a predictor (HR = 1.27, CI 1.10-1.47) of dropout in patients without ascites (24%). In NASH patients, morbid obesity (HR = 1.21, CI 1.07-1.37) and diabetes (HR = 1.15, CI 1.06-1.23) were also associated with a higher dropout risk. In patients with morbid obesity, diabetes trended towards a higher dropout risk but was not significant (HR = 1.12, CI 0.995-1.26). Conclusions Morbid obesity and diabetes are independent predictors of death in LT candidates.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1111/liv.13523

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