Post-transplant obesity is associated with poor long-term survival after liver transplantation

J. van Son, S.P. Stam, A.W. Gomes Neto, J. Blokzijl, A.P. van den Berg, R.J. Porte, S.J.L. Bakker, V.E. de Meijer

Thursday 14 march 2019

13:33 - 13:35h at Tropentheater

Categories: Klinisch/Basaal, Parallelsessie

Parallel session: Parallelsessie XV – Basaal / Klinisch 2

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 remain controversial. Because pre-transplant body mass index (BMI) can be confounded by for example ascites, we hypothesized that post-transplant BMI at 1 year could be a predictor of long term survival.

Methods: In a single-center retrospective cohort study 370 adult OLT recipients were included. Baseline BMI was set at 1 year post-transplantation to represent a stable condition. Patients were stratified into 3 BMI categories: normal weight with BMI2(n=184), overweight with 25≤BMI≤30 kg/m²(n=136), and obese with BMI>30 kg/m²(n=50). Survival analyses were performed according to Kaplan-Meier with log-rank testing, followed by Cox proportional-hazards regression analyses.

Results: After a median follow-up of 12.3 years (interquartile range 8.4-17.5 years), 132 (35.6%) patients deceased. As a continuous variable, higher BMI was inversely associated with 15 year overall survival (HR = 1.07, 95% CI: 1.02-1.12, P= 0.002), independent of age, sex, and total body muscle mass measured by urinary creatinine excretion rate. Obese OLT recipients had a significantly decreased 15 years survival of 56%, when compared to 75% survival rate of normal weight OLT recipients (HR = 1.80, 95% CI: 1.07-3.03, P= 0.026).

Conclusions: Post-transplant BMI is inversely associated with long-term survival after OLT. Obesity at 1 year post-transplantation is associated with poor survival, which may offer potential interventional strategies (i.e. dietary advice and lifestyle modification) to improve long-term survival of obese OLT recipients.