Public Release:  Morbidity higher in obese liver transplant recipients with diabetes

Survival not impacted

Wiley

Researchers from New Zealand report that morbidity following liver transplant is highest among obese patients with diabetes, but these risk factors do not influence post-transplant survival. According to the study published in Liver Transplantation, a journal of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, body mass index (BMI) is effective for assessing obesity in liver transplant patients.

One of the greatest health concerns in developed countries is the increase in obesity, diabetes, and metabolic syndrome, which is a combination of high blood pressure (hypertension), blood sugar (hyperglycaemia), and cholesterol (dyslipidemia) along with increased belly fat. In fact, the World Health Organization (WHO) reported in 2008 that 1.4 billion adults were overweight, and of these 200 million men and 300 million women were obese.

Prior research shows that liver transplant recipients who develop post-transplant diabetes and metabolic syndrome are at increased risk of cardiovascular disease. Moreover, while death and graft loss resulting from organ rejection has improved in past 30 years, up to 42% of non-graft related deaths are attributed to cardiovascular disease according to a 2002 study by Vogt et al.

"There is much evidence on post-transplant obesity and metabolic syndrome. However, the impact of pre-transplant obesity, hypertension and coronary artery disease on post-transplant outcomes has received less attention and is the focus of our study." said lead author Dr. Adam Bartlett with the New Zealand Liver Transplant Unit at Auckland City Hospital.

For the present study, researchers recruited 202 consecutive patients undergoing liver transplantation at a New Zealand center between 2000 and 2010. BMI and percentage of body fat were measured before the transplant to compare methods. Analyses of pre-transplant risk factors such as obesity, diabetes, coronary artery disease were conducted.

Participants undergoing liver transplant had a mean age of 51 years and 67% were male with most common reason for being hepatitis C cirrhosis. The BMI was available for 192 patients--4% were underweight, 27% normal weight, 26% overweight, 28% obese, 9% severely obese and 6% morbidly obese. Researchers determined that BMI and measured body fat were similar in 86% of the study group.

Further analyses indicate that obesity was an independent risk factor for diabetes and post-transplant complications. Diabetes in conjunction with obesity was the strongest predictor of complications following transplant and longer hospital stays. Metabolic risk factors did not affect 30-day, 1-year or 5-year survival for liver transplant recipients.

"Our study confirms that BMI is an appropriate measure of body fat and obesity alone should not prevent patients from receiving liver transplants," concludes Dr. Bartlett. "Identifying modifiable risk factors during the pre-transplant assessment allows for earlier interventions including weight control, diabetes management, and coronary interventions such as stenting, all which may improve long-term outcomes following liver transplantation."

###

This study is published in Liver Transplantation. Media wishing to receive a PDF of the article may contact sciencenewsroom@wiley.com.

Full citation: "The Additive Effect of Pre-Transplant Obesity, Diabetes and Cardiovascular Risk Factors On Outcome After Liver Transplantation." Anna J. Dare, Lindsay D. Plank, Anthony R.J. Phillips, Edward J. Gane, Barry Harrison, David Orr, Yannan Jiang and Adam S.J.R. Bartlett. Liver Transplantation; (DOI: 10.1002/lt.23818) Published Online: January 7, 2014.

URL: http://onlinelibrary.wiley.com/doi/10.1002/lt.23818/abstract.

About the Journal

Liver Transplantation is published by Wiley on behalf of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. Since the first application of liver transplantation in a clinical situation was reported more than twenty years ago, there has been a great deal of growth in this field and more is anticipated. As an official publication of the AASLD and the ILTS, Liver Transplantation delivers current, peer-reviewed articles on surgical techniques, clinical investigations and drug research -- the information necessary to keep abreast of this evolving specialty. For more information, please visit http://wileyonlinelibrary.com/journal/lt.

About Wiley

Wiley is a global provider of content-enabled solutions that improve outcomes in research, education, and professional practice. Our core businesses produce scientific, technical, medical, and scholarly journals, reference works, books, database services, and advertising; professional books, subscription products, certification and training services and online applications; and education content and services including integrated online teaching and learning resources for undergraduate and graduate students and lifelong learners.

Founded in 1807, John Wiley & Sons, Inc. (NYSE: JWa, JWb), has been a valued source of information and understanding for more than 200 years, helping people around the world meet their needs and fulfill their aspirations. Wiley and its acquired companies have published the works of more than 450 Nobel laureates in all categories: Literature, Economics, Physiology or Medicine, Physics, Chemistry, and Peace. Wiley's global headquarters are located in Hoboken, New Jersey, with operations in the U.S., Europe, Asia, Canada, and Australia. The Company's website can be accessed at http://www.wiley.com.

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.