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Weighing the risks: Morbid obesity and diabetes are associated with increased risk of death on the liver transplant waiting list
Author(s) -
Kardashian Ani A.,
Dodge Jennifer L.,
Roberts John,
Brandman Danielle
Publication year - 2018
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.13523
Subject(s) - medicine , diabetes mellitus , obesity , morbid obesity , hazard ratio , fatty liver , steatohepatitis , weight loss , endocrinology , confidence interval , disease
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/m 2 ). 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/m 2 , candidates with BMI ≥ 40 kg/m 2 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.