Post-transplant obesity impacts long-term survival after liver transplantation
Open accessAbstract
Background Short-term survival after orthotopic liver transplantation (OLT) has improved over the past decades, but long-term survival remains impaired. The effects of obesity on long-term survival after OLT are controversial. Because pre-transplant body mass index (BMI) can be confounded by ascites, we hypothesized that post-transplant BMI at 1 year could predict long-term survival. Methods A post-hoc analysis was performed of an observational cohort study consisting of adult recipients of a first OLT between 1993 and 2010. Baseline BMI was measured at 1-year post-transplantation to represent a stable condition. Recipients were stratified into normal weight (BMI < 25 kg/m 2 ), overweight (25 ≤ BMI ≤ 30 kg/m 2 ), and obese (BMI > 30 kg/m 2 ). Kaplan-Meier survival analyses were performed with log-rank testing, followed by multivariable Cox proportional hazards regression analysis. Results Out of 370 included recipients, 184 had normal weight, 136 were overweight, and 50 were obese at 1-year post-transplantation. After median follow-up for 12.3 years, 107 recipients had died, of whom 46 (25%) had normal weight, 39 (29%) were overweight, and 22 (44%) were obese (log-rank P = 0.020). Obese recipients had a significantly increased mortality risk compared to normal weight recipients (HR 2.00, 95% CI 1.08–3.68, P = 0.027). BMI was inversely associated with 15 years patient survival (HR 1.08, 95% CI 1.03–1.14, P = 0.001 per kg/m 2 ), independent of age, gender, muscle mass, transplant characteristics, cardiovascular risk factors, kidney- and liver function. Conclusion Obesity at 1-year post-transplantation conveys a 2-fold increased mortality risk, which may offer potential for interventional strategies (i.e. dietary advice, lifestyle modification, or bariatric surgery) to improve long-term survival after OLT.
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Obesity after liver transplantation is independently associated with a 2-fold higher mortality risk.
“Obesity after liver transplantation is independently associated with a 2fold higher mortality risk. 511”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [511]
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- Authors
- van Son, J., Stam, S. P., Gomes-Neto, A. W., Osté, M. C. J., Blokzijl, H., van den Berg, A. P., Porte, R. J., Bakker, S. J. L., & de Meijer, V. E.
- Affiliations
- University Medical Center Groningen (NL)
- ORCID
- Venue
- Metabolism
- Publisher
- Elsevier BV
- Published
- 2020-05
- Volume
- 106
- Pages
- 154204
- ISSN
- 0026-0495 (ISSN-L)
- OpenAlex
- W3011208947
- Cited by
- 70
- References
- 52
- Citations by year
- 2026: 11 · 2025: 12 · 2024: 14 · 2023: 12 · 2022: 11 · 2021: 4 · 2020: 6
- FWCI
- 7.53
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Metabolism (publishedVersion, cc-by)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Surgery › Organ Transplantation Techniques and Outcomes
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Health Sciences › Medicine › Surgery › Transplantation: Methods and Outcomes
- Keywords
- liver transplantation, post-transplant obesity, body mass index, long-term survival, mortality risk, overweight, ascites, bariatric surgery, lifestyle modification
- MeSH terms
- Adult, Female, Follow-Up Studies, Humans, Liver Function Tests, Male, Middle Aged, Obesity, Postoperative Complications, Risk Factors, Cohort Studies, Body Mass Index, Survival Analysis, Liver Transplantation, Overweight, End Stage Liver Disease
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