Nonlinear Relationship Between Body Mass Index and Liver Transplant Outcomes: A Dose-Response Meta-Analysis

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings Pub Date : 2025-01-21 DOI:10.1016/j.transproceed.2024.12.019

Chengze Liang , Saifu Yin , Turun Song , Tao Lin

{"title":"Nonlinear Relationship Between Body Mass Index and Liver Transplant Outcomes: A Dose-Response Meta-Analysis","authors":"Chengze Liang , Saifu Yin , Turun Song , Tao Lin","doi":"10.1016/j.transproceed.2024.12.019","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Weight management was recommended to have more access to transplantation and improve transplant outcomes after liver transplantation (LT). However, the dose-response relationship between body mass index (BMI) and transplant outcomes has not been clearly defined.</div></div><div><h3>Methods</h3><div>PubMed, Embase, Web of Science, and Cochrane Library databases were searched up to October 20th, 2019. Dose-response meta-analyses was conducted to establish the dose-response relationship pattern.</div></div><div><h3>Results</h3><div>Twenty-three observational studies were eligible. In the pair-wise analysis, compared with normal BMI, HRs in underweight, overweight, obesity-I, obesity-II, and obesity-III were 2.13, 0.96, 1.06, 1.36, and 1.97 for patient death, and 3.08, 1.02, 1.25, 1.58, and 2.90, for graft loss. In the dose-response analysis, U-shaped relationships were observed between BMI and both patient and graft survival (<em>P < .</em>001, <em>P < .</em>001). Referring to 17.5kg/m<sup>2</sup>, the patient death risk decreased to 0.72 (95% CI: 0.62-0.84) in 27kg/m<sup>2</sup> and then increased to 1.44 (95% CI:1.09-1.90) in 28.7-42kg/m<sup>2</sup>. Comparing to 17.5kg/m<sup>2</sup>, individuals in 26.7-28.0kg/m<sup>2</sup> had the least risk of graft loss with HR of 0.62 (95% CI:0.48-0.80) and increased to 1.64 (95% CI:1.03-2.61) in 42kg/m<sup>2</sup>. Subgroup analyses by age, sex, sample size, duration of follow-up, location, publication year, and study type presented similar results.</div></div><div><h3>Conclusion</h3><div>Underweight and severe obesity are associated with a significantly increased risk of graft loss and patient death after liver transplantation. Overweight, especially BMI of 26-28 kg/m<sup>2</sup>, may have extra survival benefit. Weight management before liver transplantation may be necessary.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 2","pages":"Pages 312-323"},"PeriodicalIF":0.8000,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Transplantation proceedings","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S004113452400695X","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"IMMUNOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Weight management was recommended to have more access to transplantation and improve transplant outcomes after liver transplantation (LT). However, the dose-response relationship between body mass index (BMI) and transplant outcomes has not been clearly defined.

Methods

PubMed, Embase, Web of Science, and Cochrane Library databases were searched up to October 20th, 2019. Dose-response meta-analyses was conducted to establish the dose-response relationship pattern.

Results

Twenty-three observational studies were eligible. In the pair-wise analysis, compared with normal BMI, HRs in underweight, overweight, obesity-I, obesity-II, and obesity-III were 2.13, 0.96, 1.06, 1.36, and 1.97 for patient death, and 3.08, 1.02, 1.25, 1.58, and 2.90, for graft loss. In the dose-response analysis, U-shaped relationships were observed between BMI and both patient and graft survival (P < .001, P < .001). Referring to 17.5kg/m², the patient death risk decreased to 0.72 (95% CI: 0.62-0.84) in 27kg/m² and then increased to 1.44 (95% CI:1.09-1.90) in 28.7-42kg/m². Comparing to 17.5kg/m², individuals in 26.7-28.0kg/m² had the least risk of graft loss with HR of 0.62 (95% CI:0.48-0.80) and increased to 1.64 (95% CI:1.03-2.61) in 42kg/m². Subgroup analyses by age, sex, sample size, duration of follow-up, location, publication year, and study type presented similar results.

Conclusion

Underweight and severe obesity are associated with a significantly increased risk of graft loss and patient death after liver transplantation. Overweight, especially BMI of 26-28 kg/m², may have extra survival benefit. Weight management before liver transplantation may be necessary.

查看原文本刊更多论文

体重指数与肝移植结果的非线性关系：一项剂量-反应荟萃分析。

背景：体重管理被推荐为肝移植（LT）后获得更多的移植机会和改善移植结果。然而，体重指数（BMI）与移植结果之间的剂量-反应关系尚未明确定义。方法：检索截至2019年10月20日的PubMed、Embase、Web of Science和Cochrane Library数据库。采用剂量-反应荟萃分析建立剂量-反应关系模式。结果：23项观察性研究符合条件。在两两分析中，与正常BMI相比，体重不足、超重、肥胖- i、肥胖- ii和肥胖- iii组患者死亡的hr分别为2.13、0.96、1.06、1.36和1.97，移植物丢失的hr分别为3.08、1.02、1.25、1.58和2.90。在剂量-反应分析中，BMI与患者和移植物存活之间呈u型关系（P < 0.001, P < 0.001）。以17.5kg/m2为参照，27kg/m2时患者死亡风险降至0.72 (95% CI: 0.62-0.84)， 28.7-42kg/m2时患者死亡风险上升至1.44 （95% CI:1.09-1.90）。与17.5kg/m2相比，26.7 ~ 28.0kg/m2的个体移植物损失风险最小，HR为0.62 (95% CI:0.48 ~ 0.80)，而42kg/m2的个体移植物损失风险增加至1.64 （95% CI:1.03 ~ 2.61）。按年龄、性别、样本量、随访时间、地点、出版年份和研究类型进行的亚组分析结果相似。结论：体重不足和严重肥胖与肝移植术后移植物丢失和患者死亡的风险显著增加相关。超重，特别是体重指数在26-28 kg/m2，可能有额外的生存益处。肝移植前的体重控制可能是必要的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

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.