AIM: Typically, a large BMI (body mass index) is associated with poor health as it can lead to a variety of diseases; we investigate frequency and complications due to change in BMI post-liver transplantation from the baseline weight and how this impacts mortality.

Methods: We evaluated all patients at a single center who received liver transplantation once between the years 2000 and 2011 with no evidence of decompensation at initial hepatology visit (t_b), including no ascites and Model for End-Stage Liver Disease (MELD) score ≤9. Patients with initial decompensation were excluded in order to study change in dry weight of cirrhotics through the course of transplantation.

The BMI of patients meeting criteria was calculated at (t_b), 1 year before transplant, at transplant (t₀), and post-liver transplant (6 months, 1 year (t₁), and 2 years (t₂)). A BMI increase or decrease >5 from (t_b) to (t₁ and t₂ respectively) was considered a marked increase or decrease for that respective time-point. A comparison was made from (t_b) to (t₁) and (t₂) as well as from (t₀) to (t₁) and (t₂). Mortality was compared at 1, 3, and 5 years post transplant.

Results: Of 130 patients meeting study criteria, mean BMI at baseline evaluation was 29.2±5.5 (Range: 16.8-43.9). Mean BMI at transplant was 28.2±5.6 (Range: 17.9-41.3). 3% of patients had BMI>40 at liver transplant. 4% of patients had BMI<20 at liver transplant. The majority (n=80, 65%) of the patients initially lost weight from (t_b) to the time of the (t₀) and then regained the weight after transplant to return to their prior weight range without a marked BMI change. 13 patients (11 %) had a net decrease in BMI of at least 5 kg/m2 from t_b to t₂. 3 and 5 year survival for patients who had this decrease in BMI post-transplant was significantly reduced (69%, 64% respectively) compared to controls (95%, 86%) (p=0.008, 0.089). 9 patients (7%) had net increase of at least 5 kg/m2 in their BMI from t_b to t₂. The survival at 3 and 5 years post-transplant for these patients was statistically similar (89%, 88% respectively) compared to controls (93%, 83%).

Conclusion: Our study demonstrates that patients after liver transplantation generally return back to their baseline BMI. Net increase in BMI did not increase mortality at 3 and 5 years after transplant. Significant reduction in BMI after transplant led to a poor survival outcome, likely reflecting medical illness after liver transplantation.

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