Post-transplant Outcome of Lean Compared to Obese Nonalcoholic Steatohepatitis in the United States: The Obesity Paradox.
BACKGROUND AND AIM: Morbid obesity is considered a relative contraindication for LT (Liver Transplant). We investigated if BMI (lean vs. obese) is a risk factor for post-LT graft and overall survival in NASH and non-NASH patients. METHODS: Using the UNOS database, LT recipients from 01/2002 to 06/2013 (age ≥18 yrs.) with follow up until 2017 were included. The association of BMI categories calculated at LT with graft and overall survival after LT were examined. RESULTS: After adjusting for confounders, all obesity cohorts (Overweight, Class I, Class II, and Class III obesity) among LT recipients for NASH had significantly reduced risk of graft and patient loss at 10 years follow up compared to the lean BMI cohort. In contrast, non-NASH group of LT recipients had no increased risk for graft and patient loss for overweight, Class I, Class II obesity groups, but had significantly increased the risk for graft (p<0.001) and patient loss (p=0.005) in the Class III obesity group. CONCLUSION: In this retrospective analysis of UNOS database, adult recipients selected for first LT, NASH patients with the lowest BMI have the worse long-term graft and patient survival as opposed to non-NASH patients where the survival was worse with higher BMI.
Satapathy, SK; Jiang, Y; Agbim, U; Wu, C; Bernstein, DE; Teperman, LW; Kedia, SK; Aithal, GP; Bhamidimarri, KR; Duseja, A; Maiwall, R; Maliakkal, B; Jalal, P; Patel, K; Puri, P; Ravinuthala, R; Wong, VW-S; Abdelmalek, MF; Ahmed, A; Thuluvath, PJ; Singal, AK; Global NAFLD Consortium,
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