William F. Balistreri, MD


April 05, 2016

In This Article

Identifying New Outcomes and Rethinking Old Ones

Impact of Being Overweight in Late Adolescence

Hagström and colleagues[18] investigated whether being overweight predicts for the development of liver disease and decompensated liver disease later in life by analyzing data from 49,321 men (age range, 18-21 years) conscripted to military service in Sweden before 1970. Data were collected from the national patient register to identify any diagnosis of liver disease at a Swedish hospital from time of conscription until the end of 2009. Mean BMI at conscription was 20.97 kg/m2, with 6.6% having a BMI > 25 kg/m2 and 0.8% having a BMI > 30 kg/m2. During a follow-up period of approximately 38 years, 525 persons were diagnosed with liver disease; approximately 40% developed decompensated liver disease. A BMI > 25 kg/m2 was significantly associated with development of decompensated liver disease.

Being overweight in late adolescence was significantly associated with the development of decompensated liver disease later in life. Mean time to decompensation was 29.8 years. These results highlight the crucial importance of efforts at maintaining a healthy lifestyle.

Liver Transplantation, Survival Benefit in Obese Patients

Over 85% of US transplant centers adhere to national practice guidelines that consider morbid obesity a contraindication to liver transplantation, on the basis of inferior post-liver transplantation survival compared with nonobese patients.

Schlansky and coworkers[19] evaluated the association of BMI with wait-list and post-liver transplantation outcomes, and calculated a survival benefit for obese patients wait-listed for liver transplantation.[19] The United Network for Organ Sharing database reported that 3.9% of 80,221 wait-listed patients and 3.5% of 38,177 patients who received transplant were morbidly obese. The patients with morbid obesity derived greater survival benefit from liver transplantation than patients with a normal BMI (71% vs 62% mortality reduction).

The authors stated that morbid obesity is no longer associated with adverse outcomes after liver transplantation and should not be viewed as a contraindication to liver transplantation. Higher wait-list mortality and greater survival benefit in morbidly obese persons indicate a disadvantage in access to liver transplantation relative to patients with lower weight.

NASH-Related Hepatocellular Carcinoma

Implementation of the Model for End-Stage Liver Disease (MELD) exception for eligible patients with HCC has had clear ramifications. Specifically, it has led to an increasing number of patients with HCC on the liver transplantation wait-list and higher MELD scores at the time of liver transplantation.

Young and colleagues[20] evaluated etiology-specific differences in active MELD exception status among patients with HCC undergoing liver transplantation in the United States and its effect on probability of liver transplantation and post-transplantation survival. Adults listed for liver transplantation with HCC secondary to NASH are significantly less likely to have active MELD exception status compared with patients who have HCC secondary to hepatitis C virus. Patients with HCC secondary to NASH are also less likely to undergo liver transplantation, but those who undergo liver transplantation have similar post-transplant survival to patients with HCC related to hepatitis C virus.


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