Morbid obesity increases death and dropout from the liver transplantation waiting list: A prospective cohort study.

Abstract

Liver transplant (LT) candidates with a body mass index (BMI) over 40 kg/m2 have lower access to a liver graft without clear explanation. Thus, we studied the impact of obesity on the waiting list (WL) and aimed to explore graft proposals and refusal.

METHOD:

Data between January 2007 and December 2017 were extracted from the French prospective national database: CRISTAL. Competing risk analyses were performed to evaluate predictors of receiving LT. Competitive events were (1) death/WL removal for disease aggravation or (2) improvement. The link between grade obesity, grafts propositions, and reason for refusal was studied.

RESULTS:

15,184 patients were analysed: 10,813 transplant, 2847 death/dropout for aggravation, 748 redirected for improvement, and 776 censored. Mortality/dropout were higher in BMI over 35 (18% vs. 14% 1 year after listing) than in other candidates. In multivariate analysis, BMI>35, age, hepatic encephalopathy, and ascites were independent predictors of death/dropout. Candidates with a BMI ≥ 35 kg/m2 had reduced access to LT, without differences in graft proposals. However, grafts refusal was more frequent especially for 'morphological incompatibility' (14.9% vs. 12.7% p < 0.01).

CONCLUSION:

BMI over 35 kg/m2 reduces access to LT with increased risk of dropout and mortality. Increased mortality and dropout could be due to a lower access to liver graft secondary to increased graft refusal for morphological incompatibility.

• Authors: Claire Delacôte, Mathilde Favre, Medhi El Amrani, Massih Ningarhari, Elise Lemaitre, Line Carolle Ntandja-Wandji, Pierre Bauvin, Emmanuel Boleslawski, Guillaume Millet, Stephanie Truant, Philippe Mathurin, Alexandre Louvet, Valérie Canva, Gilles Lebuffe, François René Pruvot, Sébastien Dharancy, Guillaume Lassailly, French ABM study group
• Journal: United European gastroenterology journal (United European Gastroenterol J) Vol. 10 Issue 4 Pg. 396-408 (05 2022) ISSN: 2050-6414 [Electronic] England
• PMID: 35470965 (Publication Type: Journal Article)
• Copyright: © 2022 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC on behalf of United European Gastroenterology.

Topics

• Humans
• Liver Transplantation
• Obesity, Morbid (complications, epidemiology, surgery)
• Prospective Studies
• Risk Assessment
• Waiting Lists