Rate of Change in Body Mass Index Prior to Liver Transplantation is Independently Associated with Post-Transplant Survival
1Hospital of the University of Pennsylvania, Philadelphia, PA, 2University of Miami, Miami, FL
Meeting: 2020 American Transplant Congress
Abstract number: A-173
Keywords: Liver transplantation, Obesity, Risk factors
Session Information
Session Name: Poster Session A: Liver: Recipient Selection
Session Type: Poster Session
Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
Location: Virtual
*Purpose: Patients at the extremes of body mass index (BMI) have poorer outcomes after liver transplantation (LT). Current national guidelines regard BMI ≥40 to be a relative contraindication to LT, and list BMI <18.5 as an additional predictor of poor outcomes. However, significant changes in BMI may occur between listing and LT, and to date no studies have evaluated the impact of these changes on post-LT survival.
*Methods: We conducted a retrospective cohort study using the United Network for Organ Sharing dataset of patients age ≥18 years who received LT from 2002 to 2017, and who were waitlisted for no longer than one year. We identified the BMI at listing and at LT, and computed the rate of change in BMI for each patient (i.e. BMI slope). Adjusted analyses using logistic regression were performed, including an interaction term between BMI at listing and the BMI slope. We then derived predicted probabilities of post-transplant mortality at 3, 6, and 12 months and constructed contour plots to display the relationship between BMI at listing and rate of change in BMI leading up to transplantation.
*Results: We identified 6,011 patients who received LT with changing BMI, with median time 5.09 months to LT (interquartile range 2.62 – 8.05). Cohort characteristics are shown in Table 1. The interaction term was statistically significant at each post-LT time point (p<0.05), adjusting for age, model for end-stage liver disease (MELD) score, etiology of liver disease, and presence of ascites. The impact of changing BMI on post-LT survival varied significantly by the initial BMI at listing, with similar patterns of changing risk at 3, 6, and 12 months after LT (Figure 1).
*Conclusions: Post-LT survival is independently associated with BMI at listing and rate of change in BMI leading up to transplant. Patients with initial BMI >35 who gain weight prior to LT have poorer outcomes, as do those with BMI <30 who lose weight. In contrast, patients in these groups who lose weight and gain weight, respectively, have excellent short-term post-LT survival.
To cite this abstract in AMA style:
Mahmud N, Saiman Y, Serper M, Weinberg E, Rothstein K, Goldberg D. Rate of Change in Body Mass Index Prior to Liver Transplantation is Independently Associated with Post-Transplant Survival [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/rate-of-change-in-body-mass-index-prior-to-liver-transplantation-is-independently-associated-with-post-transplant-survival/. Accessed May 11, 2025.« Back to 2020 American Transplant Congress