Morbid obesity increases death and dropout from the liver transplantation waiting list: A prospective cohort study. Issue 4 (26th April 2022)

• Record Type: Journal Article
• Authors: Delacôte, Claire; Favre, Mathilde; El Amrani, Medhi; Ningarhari, Massih; Lemaitre, Elise; Ntandja‐Wandji, Line Carolle; Bauvin, Pierre; Boleslawski, Emmanuel; Millet, Guillaume; Truant, Stephanie; Mathurin, Philippe; Louvet, Alexandre; Canva, Valérie; Lebuffe, Gilles; Pruvot, François René; Dharancy, Sébastien; Lassailly, Guillaume
• Other Names: Di Martino Vincent investigator.; Turco Célia investigator.; Doussot Alexandre investigator.; Chiche Laurence investigator.; Laurent Christophe investigator.; Chermak Faiza investigator.; Hiriart Jean‐Baptiste investigator.; Buchard Benjamin investigator.; Buc Emmanuel investigator.; Dondero Federica investigator.; Sepulveda Ailton investigator.; Roux Olivier investigator.; Francoz Claire investigator.; Bout Hélène investigator.; Holleville Mathilde investigator.; Duvoux Christophe investigator.; Jost Paul‐Henri investigator.; Girard Edouard investigator.; Abba Julio investigator.; Chirica Mircea investigator.; Decaens Thomas investigator.; Mabrut Jean‐Yves investigator.; Lesurtel Mickael investigator.; Antonini Teresa investigator.; Lebosse Fanny investigator.; Poinsot Domitille investigator.; Lambert Dominique investigator.; Gregoire Emilie investigator.; Chopinet Sophie investigator.; Decoster Claire investigator.; Panaro Fabrizio investigator.; Pageaux Georges‐Philippe investigator.; Vachiery‐Lahaye Florence investigator.; Herrero Astrid investigator.; Ursic‐Bedoya José investigator.; Anty Rodolphe investigator.; Gugenheim Jean investigator.; Goumard Claire investigator.; Savier Eric investigator.; Scatton Olivier investigator.; Mazzola Alessandra investigator.; Mallet Maxime investigator.; Conti Filomena investigator.; Boudjema Karim investigator.; Sulpice Laurent investigator.; Bardou Jacquet Edouard investigator.; Jezequel Caroline investigator.; Houssel‐Debry Pauline investigator.; Bergeat Damien investigator.; Bachellier Philippe investigator.; Besch Camille investigator.; Faitot François investigator.; Addeo Pietro investigator.; Michard Baptiste investigator.; Maulat Charlotte investigator.; Muscari Fabrice investigator.; Kamar Nassim investigator.; Venhard Jean‐Christophe investigator.; Salame Ephrem investigator.; Barbier Louise investigator.; Bucur Petru investigator.; Tabchouri Nicolas investigator.; Brunault Paul investigator.; Cherqui Daniel investigator.; Saliba Faouzi investigator.; Coilly Audrey investigator.; Vibert Eric investigator.; Samuel Didier investigator.; Adam René investigator.;
• Is Part Of: United European Gastroenterology journal. Volume 10:Issue 4(2022)
• Page Start: 396
• Page End: 408
• Publication Date: 2022-04-26
• Subjects: access to liver graft -- body‐mass index -- dropout -- graft refusal -- liver transplantation -- LT -- morbid obesity -- mortality -- severe obesity -- waitlist; Gastroenterology -- Periodicals; Periodicals; 616.33005
• DOI: 10.1002/ueg2.12226
• Languages: English
• ISSNs: 2050-6406

Abstract

Abstract: Liver transplant (LT) candidates with a body mass index (BMI) over 40 kg/m 2 have lower access to a liver graft without clear explanation. Thus, we studied the impact of obesity on the waiting list (WL) and aimed to explore graft proposals and refusal. Method: Data between January 2007 and December 2017 were extracted from the French prospective national database: CRISTAL. Competing risk analyses were performed to evaluate predictors of receiving LT. Competitive events were (1) death/WL removal for disease aggravation or (2) improvement. The link between grade obesity, grafts propositions, and reason for refusal was studied. Results: 15, 184 patients were analysed: 10, 813 transplant, 2847 death/dropout for aggravation, 748 redirected for improvement, and 776 censored. Mortality/dropout were higher in BMI over 35 (18% vs. 14% 1 year after listing) than in other candidates. In multivariate analysis, BMI>35, age, hepatic encephalopathy, and ascites were independent predictors of death/dropout. Candidates with a BMI ≥ 35 kg/m 2 had reduced access to LT, without differences in graft proposals. However, grafts refusal was more frequent especially for 'morphological incompatibility' (14.9% vs. 12.7% p < 0.01). Conclusion: BMI over 35 kg/m 2 reduces access to LT with increased risk of dropout and mortality. Increased mortality and dropout could be due to a lower access to liver graft secondary to increased graft refusal for morphological incompatibility. Abstract :