Increased morbidity in overweight and obese liver transplant recipients: A single-center experience of 1325 patients from the United Kingdom

Authors

  • Abdul R. Hakeem,

    1. Department of Hepatopancreatobiliary and Transplant Surgery, St. James's University Hospital, Leeds Teaching Hospitals National Health Service Trust, Leeds, United Kingdom
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  • Andrew J. Cockbain,

    1. Department of Hepatopancreatobiliary and Transplant Surgery, St. James's University Hospital, Leeds Teaching Hospitals National Health Service Trust, Leeds, United Kingdom
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  • Syed S. Raza,

    1. Department of Hepatopancreatobiliary and Transplant Surgery, St. James's University Hospital, Leeds Teaching Hospitals National Health Service Trust, Leeds, United Kingdom
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  • Stephen G. Pollard,

    1. Department of Hepatopancreatobiliary and Transplant Surgery, St. James's University Hospital, Leeds Teaching Hospitals National Health Service Trust, Leeds, United Kingdom
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  • Giles J. Toogood,

    1. Department of Hepatopancreatobiliary and Transplant Surgery, St. James's University Hospital, Leeds Teaching Hospitals National Health Service Trust, Leeds, United Kingdom
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  • Magdy A. Attia,

    1. Department of Hepatopancreatobiliary and Transplant Surgery, St. James's University Hospital, Leeds Teaching Hospitals National Health Service Trust, Leeds, United Kingdom
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  • Niaz Ahmad,

    1. Department of Hepatopancreatobiliary and Transplant Surgery, St. James's University Hospital, Leeds Teaching Hospitals National Health Service Trust, Leeds, United Kingdom
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  • Ernest L. Hidalgo,

    1. Department of Hepatopancreatobiliary and Transplant Surgery, St. James's University Hospital, Leeds Teaching Hospitals National Health Service Trust, Leeds, United Kingdom
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  • K. Raj Prasad,

    1. Department of Hepatopancreatobiliary and Transplant Surgery, St. James's University Hospital, Leeds Teaching Hospitals National Health Service Trust, Leeds, United Kingdom
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  • Krishna V. Menon

    Corresponding author
    • Department of Hepatopancreatobiliary and Transplant Surgery, St. James's University Hospital, Leeds Teaching Hospitals National Health Service Trust, Leeds, United Kingdom
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  • Krishna V. Menon conceptualized the study design and made the final corrections to the article. Abdul R. Hakeem, Andrew J. Cockbain, and Syed S. Raza collected the data needed for the study. Abdul R. Hakeem performed the statistical analysis and wrote the article. Stephen G. Pollard, Giles J. Toogood, Magdy A. Attia, Niaz Ahmad, Ernest L. Hidalgo, and K. Raj Prasad are the liver transplant consultants whose patients were used in this study. All these consultants provided input into the writing and correction of the article.

  • The study abstract was presented as a best oral abstract presentation at the International Hepato-Pancreato-Biliary Association meeting in Paris, France (July 1-5, 2012). It was also presented as the prize paper of the Association of Upper Gastrointestinal Surgeons for Great Britain and Ireland at the Digestive Disorders Federation meeting in Liverpool, United Kingdom (June 17-20, 2012).

Address reprint requests to Krishna V. Menon, M.S., F.R.C.S., Department of Hepatopancreatobiliary and Transplant Surgery, St. James's University Hospital, Leeds Teaching Hospitals National Health Service Trust, Bexley Level 3, Beckett Street, Leeds, United Kingdom LS9 7TF. Telephone: 0113-206-4887; Fax: 00441132448182; E-mail: krishna.menon@nhs.net

Abstract

Obesity levels in the United Kingdom have risen over the years. Studies from the United States and elsewhere have reported variable outcomes for obese liver transplant recipients in terms of post–liver transplant morbidity, mortality, and graft survival. This study was designed to analyze the impact of the body mass index (BMI) on outcomes following adult liver transplantation. Data from 1994 to 2009 were retrieved from a prospectively maintained database. Patients were stratified into 5 World Health Organization BMI categories: underweight (<18.5 kg/m2), normal weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), obese (30.0-34.9 kg/m2), and morbidly obese (≥35.0 kg/m2). The primary outcome was an evaluation of graft and patient survival, and the secondary outcome was an assessment of postoperative morbidity. Bonferroni correction was applied with statistical significance set at P < 0.012. Kaplan-Meier curves were used to study the effects of BMI on graft and patient survival. A total of 1325 patients were included in the study: underweight (n = 47 or 3.5%), normal-weight (n = 643 or 48.5%), overweight (n = 417 or 31.5%), obese (n = 145 or 10.9%), and morbidly obese patients (n = 73 or 5.5%). The rate of postoperative infective complications was significantly higher in the overweight (60.7%, P < 0.01) and obese recipients (65.5%, P < 0.01) versus the normal-weight recipients (50.4%). The morbidly obese patients had a longer mean intensive care unit (ICU) stay than the normal-weight patients (4.7 versus 3.2 days, P = 0.03). The mean hospital stay was longer for the overweight (22.4 days, P < 0.001), obese (21.3 days, P = 0.04), and morbidly obese recipients (22.4 days, P = 0.047) versus the normal-weight recipients (18.0 days). There was no difference in death-censored graft survival or patient survival between the groups. In conclusion, this is the largest and only reported UK series on BMI and outcomes following liver transplantation. Overweight and obese patients have significantly increased morbidity in terms of infective complications after liver transplantation and, consequently, longer ICU and hospital stays. Liver Transpl 19:551–562, 2013. © 2013 AASLD.

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