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. 2022 May;10(4):396-408.
doi: 10.1002/ueg2.12226. Epub 2022 Apr 26.

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

Claire Delacôte  1 , Mathilde Favre  2 , Medhi El Amrani  3 , Massih Ningarhari  1   2 , Elise Lemaitre  1 , Line Carolle Ntandja-Wandji  1   2 , Pierre Bauvin  1 , Emmanuel Boleslawski  3 , Guillaume Millet  3 , Stephanie Truant  3 , Philippe Mathurin  1   2 , Alexandre Louvet  1   2 , Valérie Canva  2 , Gilles Lebuffe  3   4 , François René Pruvot  3 , Sébastien Dharancy  1   2 , Guillaume Lassailly  1   2 ; French ABM study group
Collaborators, Affiliations

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

Claire Delacôte et al. United European Gastroenterol J. 2022 May.

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.

Keywords: LT; access to liver graft; body-mass index; dropout; graft refusal; liver transplantation; morbid obesity; mortality; severe obesity; waitlist.

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Conflict of interest statement

Guillaume Lassailly guaranties the integrity of the work/and declares no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flow chart
FIGURE 2
FIGURE 2
Annual prevalence of obesity in patients listed for liver transplantation in France between 2007 and 2017
FIGURE 3
FIGURE 3
(a) Overall cumulative probabilities; cumulative probabilities of (b) Liver transplant (LT), (c) death or aggravation, (d) improvement according to the BMI
FIGURE 4
FIGURE 4
Difference between BMI of the recipient and the donor according to the severe obesity of the recipient
See this image and copyright information in PMC

Comment in

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