Liver Transplantation in the Obese Cirrhotic Patient

Erin K.K. Spengler, Jacqueline G. O’Leary, Helen S. Te, Shari Rogal, Anjana A. Pillai, Abdullah Al-Osaimi, Archita Desai, James N. Fleming, Daniel Ganger, Anil Seetharam, Georgios Tsoulfas, Martin Montenovo, Jennifer C. Lai

Research output: Contribution to journalReview article

12 Citations (Scopus)

Abstract

Despite the rapidly increasing prevalence of obesity in the transplant population, the optimal management of obese liver transplant candidates remains undefined. Setting strict body mass index cutoffs for transplant candidacy remains controversial, with limited data to guide this practice. Body mass index is an imperfect measure of surgical risk in this population, partly due to volume overload and variable visceral adiposity. Weight loss before transplantation may be beneficial, but it remains important to avoid protein calorie malnutrition and sarcopenia. Intensive lifestyle modifications appear to be successful in achieving weight loss, though the durability of these interventions is not known. Pretransplant and intraoperative bariatric surgeries have been performed, but large randomized controlled trials are lacking. Traditional cardiovascular comorbidities are more prevalent in obese individuals and remain the basis for pretransplant cardiovascular evaluation and risk stratification. The recent US liver transplant experience demonstrates comparable patient and graft survival between obese and nonobese liver transplant recipients, but obesity presents important medical and surgical challenges during and after transplant. Specifically, obesity is associated with an increased incidence of wound infections, wound dehiscence, biliary complications and overall infection, and confers a higher risk of posttransplant obesity and metabolic syndrome-related complications. In this review, we examine current practices in the obese liver transplant population, offer recommendations based on the currently available data, and highlight areas where additional research is needed.

Original languageEnglish (US)
Pages (from-to)2288-2296
Number of pages9
JournalTransplantation
Volume101
Issue number10
DOIs
StatePublished - Oct 1 2017

Fingerprint

Liver Transplantation
Transplants
Obesity
Liver
Weight Loss
Body Mass Index
Population
Sarcopenia
Protein-Energy Malnutrition
Bariatric Surgery
Adiposity
Graft Survival
Wound Infection
Life Style
Comorbidity
Randomized Controlled Trials
Transplantation
Incidence
Wounds and Injuries
Infection

ASJC Scopus subject areas

  • Transplantation

Cite this

Spengler, E. K. K., O’Leary, J. G., Te, H. S., Rogal, S., Pillai, A. A., Al-Osaimi, A., ... Lai, J. C. (2017). Liver Transplantation in the Obese Cirrhotic Patient. Transplantation, 101(10), 2288-2296. https://doi.org/10.1097/TP.0000000000001794
Spengler, Erin K.K. ; O’Leary, Jacqueline G. ; Te, Helen S. ; Rogal, Shari ; Pillai, Anjana A. ; Al-Osaimi, Abdullah ; Desai, Archita ; Fleming, James N. ; Ganger, Daniel ; Seetharam, Anil ; Tsoulfas, Georgios ; Montenovo, Martin ; Lai, Jennifer C. / Liver Transplantation in the Obese Cirrhotic Patient. In: Transplantation. 2017 ; Vol. 101, No. 10. pp. 2288-2296.
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Spengler, EKK, O’Leary, JG, Te, HS, Rogal, S, Pillai, AA, Al-Osaimi, A, Desai, A, Fleming, JN, Ganger, D, Seetharam, A, Tsoulfas, G, Montenovo, M & Lai, JC 2017, 'Liver Transplantation in the Obese Cirrhotic Patient', Transplantation, vol. 101, no. 10, pp. 2288-2296. https://doi.org/10.1097/TP.0000000000001794

Liver Transplantation in the Obese Cirrhotic Patient. / Spengler, Erin K.K.; O’Leary, Jacqueline G.; Te, Helen S.; Rogal, Shari; Pillai, Anjana A.; Al-Osaimi, Abdullah; Desai, Archita; Fleming, James N.; Ganger, Daniel; Seetharam, Anil; Tsoulfas, Georgios; Montenovo, Martin; Lai, Jennifer C.

In: Transplantation, Vol. 101, No. 10, 01.10.2017, p. 2288-2296.

Research output: Contribution to journalReview article

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AU - Spengler, Erin K.K.

AU - O’Leary, Jacqueline G.

AU - Te, Helen S.

AU - Rogal, Shari

AU - Pillai, Anjana A.

AU - Al-Osaimi, Abdullah

AU - Desai, Archita

AU - Fleming, James N.

AU - Ganger, Daniel

AU - Seetharam, Anil

AU - Tsoulfas, Georgios

AU - Montenovo, Martin

AU - Lai, Jennifer C.

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Spengler EKK, O’Leary JG, Te HS, Rogal S, Pillai AA, Al-Osaimi A et al. Liver Transplantation in the Obese Cirrhotic Patient. Transplantation. 2017 Oct 1;101(10):2288-2296. https://doi.org/10.1097/TP.0000000000001794