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Systematic review with meta‐analysis: post‐operative complications and mortality risk in liver transplant candidates with obesity
Author(s) -
Barone M.,
Viggiani M. T.,
Losurdo G.,
Principi M.,
Leandro G.,
Di Leo A.
Publication year - 2017
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.14139
Subject(s) - medicine , contraindication , overweight , body mass index , obesity , liver transplantation , cochrane library , meta analysis , surgery , transplantation , alternative medicine , pathology
Summary Background International guidelines rate class III (morbid) obesity (body mass index [ BMI ]≥40 kg/m 2 ) as a relative contraindication for liver transplantation ( LT ) requiring further research. Moreover, data on the mortality risk in candidates with a BMI : 30‐34.9 and 35‐39.9 kg/m 2 (class I and class II obesity, respectively) are weak. Aim To compare post‐operative complications and mortality risks in all obese candidates vs candidates with a BMI : 18.5‐29.9 (normal/overweight) assumed as controls. Methods We searched the Cochrane library, PubMed, Scopus, Web‐of‐Science and article reference lists, restricted to the English language, and selected cohort studies analysing the following outcomes: all‐causes mortality (at 30 days, 1‐2‐3‐5 years), post‐operative and cardiopulmonary complications, hospital and intensive care unit ( ICU ) length of stay. Two reviewers independently extracted the studies data and a third one resolved discrepancies. Results Twenty‐four studies comprising 132 162 patients met the inclusion criteria. As compared to controls, mortality risk was increased at all time‐periods (except at 3 years) for a BMI ≥40, at 30 days for a BMI : 30‐34.9 and in none of the considered time‐periods for a BMI : 35‐39.9. Post‐operative complications were significantly higher for a BMI >30 and 30‐34.9. Due to the shortage/absence of data, we evaluated cardiopulmonary complications, hospital and ICU length of stay only in the BMI ≥30 category. In these patients, only cardiopulmonary complications were increased as compared to controls. Conclusions Morbid obesity has an impact on patients’ survival after LT . However, since even a BMI >30 increases post‐transplant complications, new strategies should be included in the LT programme to favour weight loss in all obese candidates.