Son, J. van (Jeffrey) (2019) Post-transplant obesity is associated with poor longterm survival after liver transplantation. thesis, Medicine.
Full text available on request.Abstract
Objectives: Short-term survival after orthotopic liver transplantation (OLT) has improved over the past decades, but long-term survival remains impaired. The effects of obesity on long-term survival after OLT are controversial. Because pre-transplant body mass index (BMI) can be confounded by ascites, we hypothesized that post-transplant BMI at 1 year could be a predictor of long term survival. Methods: In a single-center retrospective cohort study 370 adult OLT recipients were included. Baseline BMI was set at 1 year post-transplantation to represent a stable condition. Patients were stratified into 3 BMI categories: normal weight with BMI<25 kg/m2 (n=184), overweight with 25≤BMI≤30 kg/m2 (n=136), and obese with BMI>30 kg/m2 (n=50). Survival analyses were performed according to Kaplan-Meier with log-rank testing, followed by Cox proportional-hazards regression analyses. Results: After a median follow-up of 12.3 years (interquartile range 8.4-15.0 years), 107 (28.9%) patients deceased. As a continuous variable, BMI was inversely associated with 10 years survival (HR = 1.10, 95% CI: 1.05-1.16, P = 0.001) and 15 years survival (HR = 1.08, 95% CI: 1.03-1.14, P = 0.001), independent of potential confounders. Obese OLT recipients had a significantly decreased 10 years survival of 64% when compared to 80% survival of normal weight OLT recipients (HR = 2.16, 95% CI: 1.09-4.29, P = 0.027). After 15 years, survival of obese OLT recipients decreased to 56% vs. 75% survival of normal weight OLT recipients (HR = 2.00, 95% CI: 1.08-3.68, P = 0.027). Conclusion: Post-transplant BMI is inversely associated with long-term survival after OLT. Obesity at 1 year post-transplantation is associated with poor survival, which necessitates potential interventional strategies (e.g. dietary advice and lifestyle modification) to improve long-term survival of obese OLT recipients.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Supervisors: and Bakker, Prof. dr. S.J.L and & and Meijer, dr. V.E. de and Surgery, division of Hepato- pancreato-biliary surgery and L and Institution: and University Medical Center Groningen |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:05 |
| Last Modified: | 25 Jun 2020 11:05 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2502 |
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