Post-transplant obesity impacts long-term survival after liver transplantation
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 hypoth...
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| creator | van Son, Jeffrey Stam, Suzanne P. Gomes-Neto, Antonio W. Osté, Maryse C.J. Blokzijl, Hans van den Berg, Aad P. Porte, Robert J. Bakker, Stephan J.L. de Meijer, Vincent E. |
| description | 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.
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 30 kg/m2). Kaplan-Meier survival analyses were performed with log-rank testing, followed by multivariable Cox proportional hazards regression analysis.
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/m2), independent of age, gender, muscle mass, transplant characteristics, cardiovascular risk factors, kidney- and liver function.
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.
•Long-term survival after liver transplantation is impaired.•Post-transplant body mass index at 1 year was used to predict long-term survival.•Obesity at 1 year post-transplantation conveys a 2-fold increased mortality risk.•Body mass index was inversely associated with 15 years patient survival. |
| doi_str_mv | 10.1016/j.metabol.2020.154204 |
| format | Article |
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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/m2), overweight (25 ≤ BMI ≤ 30 kg/m2), and obese (BMI > 30 kg/m2). Kaplan-Meier survival analyses were performed with log-rank testing, followed by multivariable Cox proportional hazards regression analysis.
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/m2), independent of age, gender, muscle mass, transplant characteristics, cardiovascular risk factors, kidney- and liver function.
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.
•Long-term survival after liver transplantation is impaired.•Post-transplant body mass index at 1 year was used to predict long-term survival.•Obesity at 1 year post-transplantation conveys a 2-fold increased mortality risk.•Body mass index was inversely associated with 15 years patient survival.</description><identifier>ISSN: 0026-0495</identifier><identifier>EISSN: 1532-8600</identifier><identifier>DOI: 10.1016/j.metabol.2020.154204</identifier><identifier>PMID: 32173406</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Body mass index ; Liver transplantation ; Long-term ; Obesity ; Survival</subject><ispartof>Metabolism, clinical and experimental, 2020-05, Vol.106, p.154204-154204, Article 154204</ispartof><rights>2020 The Authors</rights><rights>Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c478t-4e66d3af14c4ef2edf38dad4d86fffb0c5fea0c2fc21aea3bb54713d387dbbff3</citedby><cites>FETCH-LOGICAL-c478t-4e66d3af14c4ef2edf38dad4d86fffb0c5fea0c2fc21aea3bb54713d387dbbff3</cites><orcidid>0000-0002-4398-4877 ; 0000-0001-6216-691X ; 0000-0002-7900-5917 ; 0000-0003-0286-426X ; 0000-0001-9238-1397 ; 0000-0003-0538-734X ; 0000-0003-3356-6791 ; 0000-0002-2719-5202 ; 0000-0003-4240-7506</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.metabol.2020.154204$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,3548,27923,27924,45994</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32173406$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>van Son, Jeffrey</creatorcontrib><creatorcontrib>Stam, Suzanne P.</creatorcontrib><creatorcontrib>Gomes-Neto, Antonio W.</creatorcontrib><creatorcontrib>Osté, Maryse C.J.</creatorcontrib><creatorcontrib>Blokzijl, Hans</creatorcontrib><creatorcontrib>van den Berg, Aad P.</creatorcontrib><creatorcontrib>Porte, Robert J.</creatorcontrib><creatorcontrib>Bakker, Stephan J.L.</creatorcontrib><creatorcontrib>de Meijer, Vincent E.</creatorcontrib><title>Post-transplant obesity impacts long-term survival after liver transplantation</title><title>Metabolism, clinical and experimental</title><addtitle>Metabolism</addtitle><description>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.
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/m2), overweight (25 ≤ BMI ≤ 30 kg/m2), and obese (BMI > 30 kg/m2). Kaplan-Meier survival analyses were performed with log-rank testing, followed by multivariable Cox proportional hazards regression analysis.
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/m2), independent of age, gender, muscle mass, transplant characteristics, cardiovascular risk factors, kidney- and liver function.
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.
•Long-term survival after liver transplantation is impaired.•Post-transplant body mass index at 1 year was used to predict long-term survival.•Obesity at 1 year post-transplantation conveys a 2-fold increased mortality risk.•Body mass index was inversely associated with 15 years patient survival.</description><subject>Body mass index</subject><subject>Liver transplantation</subject><subject>Long-term</subject><subject>Obesity</subject><subject>Survival</subject><issn>0026-0495</issn><issn>1532-8600</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNqFkMtOwzAQRS0EoqXwCaAs2aT4FTusEEK8pApYwNpy7DFylcTFdir170nVAks2M5rRvfM4CJ0TPCeYiKvlvIOsm9DOKaZjr-IU8wM0JRWjZS0wPkRTjKkoMb-uJugkpSXGWMpaHKMJo0QyjsUUvbyFlMscdZ9Wre5zERpIPm8K3620yaloQ_9ZZohdkYa49mvdFtqNddH69Rj_nDr70J-iI6fbBGf7PEMfD_fvd0_l4vXx-e52URou61xyEMIy7Qg3HBwF61htteW2Fs65BpvKgcaGOkOJBs2apuKSMMtqaZvGOTZDl7u5qxi-BkhZdT4ZaMdDIAxJUSalqLms-CitdlITQ0oRnFpF3-m4UQSrLUq1VHuUaotS7VCOvov9iqHpwP66ftiNgpudAMZH1x6iSsZDb8D6CCYrG_w_K74BdXqK0w</recordid><startdate>202005</startdate><enddate>202005</enddate><creator>van Son, Jeffrey</creator><creator>Stam, Suzanne P.</creator><creator>Gomes-Neto, Antonio W.</creator><creator>Osté, Maryse C.J.</creator><creator>Blokzijl, Hans</creator><creator>van den Berg, Aad P.</creator><creator>Porte, Robert J.</creator><creator>Bakker, Stephan J.L.</creator><creator>de Meijer, Vincent E.</creator><general>Elsevier Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-4398-4877</orcidid><orcidid>https://orcid.org/0000-0001-6216-691X</orcidid><orcidid>https://orcid.org/0000-0002-7900-5917</orcidid><orcidid>https://orcid.org/0000-0003-0286-426X</orcidid><orcidid>https://orcid.org/0000-0001-9238-1397</orcidid><orcidid>https://orcid.org/0000-0003-0538-734X</orcidid><orcidid>https://orcid.org/0000-0003-3356-6791</orcidid><orcidid>https://orcid.org/0000-0002-2719-5202</orcidid><orcidid>https://orcid.org/0000-0003-4240-7506</orcidid></search><sort><creationdate>202005</creationdate><title>Post-transplant obesity impacts long-term survival after liver transplantation</title><author>van Son, Jeffrey ; Stam, Suzanne P. ; Gomes-Neto, Antonio W. ; Osté, Maryse C.J. ; Blokzijl, Hans ; van den Berg, Aad P. ; Porte, Robert J. ; Bakker, Stephan J.L. ; de Meijer, Vincent E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c478t-4e66d3af14c4ef2edf38dad4d86fffb0c5fea0c2fc21aea3bb54713d387dbbff3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Body mass index</topic><topic>Liver transplantation</topic><topic>Long-term</topic><topic>Obesity</topic><topic>Survival</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>van Son, Jeffrey</creatorcontrib><creatorcontrib>Stam, Suzanne P.</creatorcontrib><creatorcontrib>Gomes-Neto, Antonio W.</creatorcontrib><creatorcontrib>Osté, Maryse C.J.</creatorcontrib><creatorcontrib>Blokzijl, Hans</creatorcontrib><creatorcontrib>van den Berg, Aad P.</creatorcontrib><creatorcontrib>Porte, Robert J.</creatorcontrib><creatorcontrib>Bakker, Stephan J.L.</creatorcontrib><creatorcontrib>de Meijer, Vincent E.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Metabolism, clinical and experimental</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>van Son, Jeffrey</au><au>Stam, Suzanne P.</au><au>Gomes-Neto, Antonio W.</au><au>Osté, Maryse C.J.</au><au>Blokzijl, Hans</au><au>van den Berg, Aad P.</au><au>Porte, Robert J.</au><au>Bakker, Stephan J.L.</au><au>de Meijer, Vincent E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Post-transplant obesity impacts long-term survival after liver transplantation</atitle><jtitle>Metabolism, clinical and experimental</jtitle><addtitle>Metabolism</addtitle><date>2020-05</date><risdate>2020</risdate><volume>106</volume><spage>154204</spage><epage>154204</epage><pages>154204-154204</pages><artnum>154204</artnum><issn>0026-0495</issn><eissn>1532-8600</eissn><abstract>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.
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/m2), overweight (25 ≤ BMI ≤ 30 kg/m2), and obese (BMI > 30 kg/m2). Kaplan-Meier survival analyses were performed with log-rank testing, followed by multivariable Cox proportional hazards regression analysis.
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/m2), independent of age, gender, muscle mass, transplant characteristics, cardiovascular risk factors, kidney- and liver function.
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.
•Long-term survival after liver transplantation is impaired.•Post-transplant body mass index at 1 year was used to predict long-term survival.•Obesity at 1 year post-transplantation conveys a 2-fold increased mortality risk.•Body mass index was inversely associated with 15 years patient survival.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>32173406</pmid><doi>10.1016/j.metabol.2020.154204</doi><tpages>1</tpages><orcidid>https://orcid.org/0000-0002-4398-4877</orcidid><orcidid>https://orcid.org/0000-0001-6216-691X</orcidid><orcidid>https://orcid.org/0000-0002-7900-5917</orcidid><orcidid>https://orcid.org/0000-0003-0286-426X</orcidid><orcidid>https://orcid.org/0000-0001-9238-1397</orcidid><orcidid>https://orcid.org/0000-0003-0538-734X</orcidid><orcidid>https://orcid.org/0000-0003-3356-6791</orcidid><orcidid>https://orcid.org/0000-0002-2719-5202</orcidid><orcidid>https://orcid.org/0000-0003-4240-7506</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Body mass index Liver transplantation Long-term Obesity Survival |
| title | Post-transplant obesity impacts long-term survival after liver transplantation |
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