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Transplantation. 2017 Oct;101(10):2288-2296. doi: 10.1097/TP.0000000000001794.

Liver Transplantation in the Obese Cirrhotic Patient.

Author information

1
1 Division of Gastroenterology and Hepatology, University of Wisconsin, Madison, WI.2 Division of Hepatology, Baylor University Medical Center, Dallas, TX.3 Center for Liver Diseases, University of Chicago Medicine, Chicago, IL.4 VA Pittsburgh Healthcare System, Department of Surgery, University of Pittsburgh, PA.5 Division of Digestive Diseases and The Emory Transplant Center, Emory University Hospital, Atlanta, GA.6 Division of Hepatology, Temple University Health System, Philadelphia, PA.7 Division of Gastroenterology and Hepatology, Department of Medicine, University of Arizona, Tucson, AZ.8 Department of Pharmacy, Medical University of South Carolina, Charleston, SC.9 Division of Gastroenterology and Hepatology, Northwestern University, Chicago, IL.10 Transplant Institute, Banner University of Arizona College of Medicine-Phoenix, Tucson, AZ.11 Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece.12 Division of Transplantation, Department of Surgery. University of Washington. Seattle, WA.13 Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Francisco, San Francisco, CA.

Abstract

Despite the rapidly increasing prevalence of obesity in the transplant population, the optimal management of obese liver transplant candidates remains undefined. Setting strict body mass index cutoffs for transplant candidacy remains controversial, with limited data to guide this practice. Body mass index is an imperfect measure of surgical risk in this population, partly due to volume overload and variable visceral adiposity. Weight loss before transplantation may be beneficial, but it remains important to avoid protein calorie malnutrition and sarcopenia. Intensive lifestyle modifications appear to be successful in achieving weight loss, though the durability of these interventions is not known. Pretransplant and intraoperative bariatric surgeries have been performed, but large randomized controlled trials are lacking. Traditional cardiovascular comorbidities are more prevalent in obese individuals and remain the basis for pretransplant cardiovascular evaluation and risk stratification. The recent US liver transplant experience demonstrates comparable patient and graft survival between obese and nonobese liver transplant recipients, but obesity presents important medical and surgical challenges during and after transplant. Specifically, obesity is associated with an increased incidence of wound infections, wound dehiscence, biliary complications and overall infection, and confers a higher risk of posttransplant obesity and metabolic syndrome-related complications. In this review, we examine current practices in the obese liver transplant population, offer recommendations based on the currently available data, and highlight areas where additional research is needed.

PMID:
28930104
PMCID:
PMC5762611
[Available on 2018-10-01]
DOI:
10.1097/TP.0000000000001794
[Indexed for MEDLINE]

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