Morbid Obesity and Liver Transplant

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings Pub Date : 2025-01-01 DOI:10.1016/j.transproceed.2024.12.003

Gerardo Moro , Arkaitz Perfecto , Jaime Encinas , Alberto Ventoso , Beatriz Villota , Patricia Ruiz , Teresa Pascual , Ibone Palomares , Mikel Prieto , Sara Mambrilla , Ander García , Mikel Gastaca

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引用次数: 0

Abstract

Background

The progressive increase in the prevalence of morbid obesity (MO) in the general population is a pressing issue. This rise in MO has also been observed in patients with liver disease who are candidates for liver transplantation (LT).

Methods

A retrospective study of a single-center series was conducted to analyze the impact of MO on morbidity, mortality, and patient survival after LT.

Results

Fifteen patients with a body mass index (BMI) of ≥ 40 kg/m² (mean 40.4 ± 2.99 SD) were transplanted from 2004 to 2023. Thirteen were 13 men (87%) and 2 women (13%), with a mean age of 55 years (±9). The most common indication for LT was liver cirrhosis (93%: 6 alcohol related, 4 hepatitis C virus [HCV] related, and 3 from other causes), and only one case was due to hepatocellular carcinoma in a non-cirrhotic liver (7%). The median stay in the Intensive Care Unit was 5 days (range 2-52), with a median total hospital stay of 15 days (range 10-103). Five patients had a major complication each (≥ IIIa on the Clavien-Dindo scale): liver re-transplantation due to primary graft failure, reoperation due to hemoperitoneum, late superior mesenteric vein (SMV) thrombosis, acute renal failure that required hemodialysis, and surgical wound infection that required drainage. The only patient who required urgent re-transplantation (7%) had an adequate subsequent recovery without other complications. None of the patients underwent obesity surgery pre-, post-, or concurrently with the LT. Patient and graft survival after 5 years was 97%.

Conclusions

In our experience, the outcomes of LT in patients with MO were satisfactory in terms of postoperative morbimortality, as well as in patient survival. Therefore, we do not support the notion of considering MO as a contraindication for LT.

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病态肥胖与肝移植。

背景：在普通人群中，病态肥胖（MO）患病率的逐渐增加是一个紧迫的问题。在肝移植（LT）候选的肝脏疾病患者中也观察到MO的上升。方法：采用单中心系列回顾性研究，分析MO对移植后发病率、死亡率和患者生存率的影响。结果：2004年至2023年，15例体重指数(BMI)≥40 kg/m2（平均40.4±2.99 SD）的患者进行了移植。其中男性13例（87%），女性2例（13%），平均年龄55岁（±9岁）。肝移植最常见的适应症是肝硬化（93%:6例与酒精有关，4例与丙型肝炎病毒[HCV]有关，3例来自其他原因），只有1例是由于非肝硬化肝脏的肝细胞癌（7%）。重症监护病房的中位数住院时间为5天（范围2-52天），总住院时间中位数为15天（范围10-103天）。5例患者各有主要并发症（Clavien-Dindo评分≥IIIa）：因初次移植物失败而再次肝移植，因腹膜出血、晚期肠系膜上静脉（SMV）血栓形成而再次手术，需要血液透析的急性肾功能衰竭，需要引流的手术伤口感染。唯一需要紧急再移植的患者（7%）术后恢复良好，无其他并发症。没有患者在lt术前、术后或同时接受过肥胖手术。5年后患者和移植物的生存率为97%。结论：根据我们的经验，就术后死亡率和患者生存而言，肝移植治疗MO患者的结果令人满意。因此，我们不支持将MO作为肝移植禁忌症的观点。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplantation proceedings 医学-免疫学

CiteScore

1.70

自引率

0.00%

发文量

502

审稿时长

60 days

期刊介绍： Transplantation Proceedings publishes several different categories of manuscripts, all of which undergo extensive peer review by recognized authorities in the field prior to their acceptance for publication. The first type of manuscripts consists of sets of papers providing an in-depth expression of the current state of the art in various rapidly developing components of world transplantation biology and medicine. These manuscripts emanate from congresses of the affiliated transplantation societies, from Symposia sponsored by the Societies, as well as special Conferences and Workshops covering related topics. Transplantation Proceedings also publishes several special sections including publication of Clinical Transplantation Proceedings, being rapid original contributions of preclinical and clinical experiences. These manuscripts undergo review by members of the Editorial Board. Original basic or clinical science articles, clinical trials and case studies can be submitted to the journal?s open access companion title Transplantation Reports.