Obese Liver Transplant Patients Not Always Higher Risk, Study Shows

Morbid obesity is considered a contraindication for the receiving a liver transplant, but a recent study at the University of Michigan shows the obese have a significant edge in survival rates compared to patients of a normal BMI. Many doctors will not approve a patient to join a transplant waiting list if he or she is overweight, largely in part to previous studies and a recommendation against it by the American Association for the Study of Liver Diseases. Researches say the more retrospective study show that patients of all sizes benefit from the surgery.

Approximately 1 in 5 of the people in the United States with end stage liver disease are morbidly obese. Those patients might be saved by a transplant, and the latest retrospective study looks at surgeries including obese patients between 2001 and 2004. After classifying over 25,000 patients by BMI and adjusting for variables, the researches found the morbidly obese (BMI >40) fared better than similar patients who merely stayed on a waiting list. Previous studies had not compared the two groups.

"Our study demonstrates a clear survival benefit for liver transplant recipients when compared to their counterparts on the waiting list, regardless of BMI," the authors report.

None of the patients with an elevated BMI had an increased incidence of mortality after transplant compared to the normal BMI. However, when comparing overweight to underweight patients who stayed on a waiting list during the same time period, the underweight patients were 61 more likely to die.

For candidates who remained on the waiting list throughout the study period, there was also no significant difference in mortality risk among the BMI groups, except for underweight patients, who were 61 percent more likely to die, compared to those with a normal BMI. The authors are suggesting that the AASLD recommendation should be reconsidered.

"Our study found that obese patients, when compared to patients with normal BMI have a similar risk of death while on the liver transplant waiting list, have similar survival rates following liver transplantation, and have a similar reduction in the risk of death," they said.

"Unlike previous studies, this study did not identify an increase in mortality for obese patients undergoing liver transplant, including morbidly obese patients. In contrast, underweight liver transplant recipients were identified to be at an increased risk of death. However, all categories of BMI demonstrated a significant survival benefit when compared to their counterparts on the waiting list. Therefore, BMI alone should not necessarily exclude patients with end-stage liver disease from access to liver transplantation," the authors conclude.

Still, the authors caution that as morbid obesity often occurs along with other conditions like diabetes and vascular disease, and the supply of organs is chronically short, obese patients with one or more other serious conditions should still not be eligible. Morbidly obese patients should still be selectively awarded transplants based on their overall health.

Source:University of Michigan, Liver Transplants Offer Benefits To Patients of All Sizes