Nutritional status of patients with alcoholic cirrhosis undergoing liver transplantation: time trends and impact on survival

Abstract

Alcoholic cirrhotics evaluated for liver transplantation are frequently malnourished or obese. We analyzed alcoholic cirrhotics undergoing transplantation to examine time trends of nutrition/weight, transplant outcome, and effects of concomitant hepatitis C virus (HCV) and/or hepatocellular carcinoma (HCC). Nutrition and transplant outcomes were reviewed for alcoholic cirrhosis with/without HCV/HCC. Malnutrition was defined by subjective global assessment. Body mass index (BMI) classified obesity. A total of 261 patients receiving transplants were separated (1988-2000, 2001-2006, and 2007-2011) to generate similar size cohorts. Mean BMI for the whole cohort was 28 ± 6 with 68% classified as overweight/obese. Mean BMI did not vary among cohorts and was not affected by HCV/HCC. While prevalence of malnutrition did not vary among cohorts, it was lower in patients with HCV/HCC (P < 0.01). One-year graft/patient survival was 90% and not impacted by time period, HCV/HCC, or malnutrition after adjusting for demographics and model end-stage liver disease (MELD). Alcoholic cirrhotics undergoing transplantation are malnourished yet frequently overweight/obese. Among patients selected for transplantation, 1-year post-transplant graft/patient survival is excellent, have not changed over time, and do not vary by nutrition/BMI. Our findings support feasibility of liver transplantation for alcoholic cirrhotics with obesity and malnutrition.

Keywords: alcoholic liver disease; hepatitis C virus; hepatocellular carcinoma; malnutrition; mortality; orthotopic liver transplantation.

Figure 1

Yearly distribution of number of patients transplanted for alcoholic cirrhosis between 1988 and 2011.

Figure 2

One-year post liver transplant graft and patient survival among patients with alcoholic cirrhosis. Comparison over time (a–b): 1988–2000 (black dashed line) vs. 2001–2006 (gray dashed line) vs. 2007–2011 (black solid line). Results show that survival for respective time period are similar for graft (89% vs. 89% vs. 96%; Log Rank P = 0.18) and for patient (90% vs. 89% vs. 96%; P = 0.23).