Morbid obesity increases death and dropout from the liver transplantation waiting list: A prospective cohort study

• Published in: United European gastroenterology journal 2022-05, Vol.10 (4), p.396-408
• Main Authors: Delacôte, Claire, Favre, Mathilde, 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, Di Martino, Vincent, Turco, Célia, Doussot, Alexandre, Chiche, Laurence, Laurent, Christophe, Chermak, Faiza, Hiriart, Jean‐Baptiste, Buchard, Benjamin, Buc, Emmanuel, Dondero, Federica, Sepulveda, Ailton, Roux, Olivier, Francoz, Claire, Bout, Hélène, Holleville, Mathilde, Duvoux, Christophe, Jost, Paul‐Henri, Girard, Edouard, Abba, Julio, Chirica, Mircea, Decaens, Thomas, Mabrut, Jean‐Yves, Lesurtel, Mickael, Antonini, Teresa, Lebosse, Fanny, Poinsot, Domitille, Lambert, Dominique, Gregoire, Emilie, Chopinet, Sophie, Decoster, Claire, Panaro, Fabrizio, Pageaux, Georges‐Philippe, Vachiery‐Lahaye, Florence, Herrero, Astrid, Ursic‐Bedoya, José, Anty, Rodolphe, Gugenheim, Jean, Goumard, Claire, Savier, Eric, Scatton, Olivier, Mazzola, Alessandra, Mallet, Maxime, Conti, Filomena, Boudjema, Karim, Sulpice, Laurent, Bardou Jacquet, Edouard, Jezequel, Caroline, Houssel‐Debry, Pauline, Bergeat, Damien, Bachellier, Philippe, Besch, Camille, Faitot, François, Addeo, Pietro, Michard, Baptiste, Maulat, Charlotte, Muscari, Fabrice, Kamar, Nassim, Venhard, Jean‐Christophe, Salame, Ephrem, Barbier, Louise, Bucur, Petru, Tabchouri, Nicolas, Brunault, Paul, Cherqui, Daniel, Saliba, Faouzi, Coilly, Audrey, Vibert, Eric, Samuel, Didier, Adam, René
• Format: Article
• Language: English
• Subjects: access to liver graft; Ascites; Body mass index; Diabetes; dropout; graft refusal; Hepatitis C; Hepatobiliary; Humans; Inscriptions; Life Sciences; Liver cancer; Liver cirrhosis; Liver diseases; Liver Transplantation; Liver transplants; morbid obesity; Morphology; Mortality; Obesity; Obesity, Morbid - complications; Obesity, Morbid - epidemiology; Obesity, Morbid - surgery; Original; Patients; Prospective Studies; Risk Assessment; severe obesity; Waiting Lists; waitlist; Weight control
• ISSN: 2050-6406; 2050-6414
• DOI: 10.1002/ueg2.12226

Liver transplant (LT) candidates with a body mass index (BMI) over 40 kg/m2 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/m2 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