Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: Body Mass Index (BMI) limits for liver transplant (LT) candidacy are controversial. We evaluated waitlist and post-LT outcomes, prognostic factors, and regional patterns of LT waitlist registration in patients with BMI ≥40 compared to those with BMI 18-39.9.
*Methods: UNOS data was analyzed for adult primary LT candidates from 3/1/2002-12/1/2017. Waitlist dropout and post-LT survival were compared at various BMI ranges. Prognostic factors were analyzed using multivariable and competing risk analyses. The distribution of waitlisted morbidly obese (BMI ≥40) patients by UNOS region was compared to the Centers for Disease Control Behavioral Risk Factors Surveillance System (BRFSS) data.
*Results: Analysis of post-LT outcomes demonstrated a small but significantly lower 1- and 3-year graft and patient survival rate for patients with BMI ≥40 vs lower BMI groups (Table 1). Risk factors for patients with BMI ≥40 included age >60 (p=0.011), prior surgery (p<0.001), and diabetes (p=0.008) on multivariable analysis. MELD >30 was significant only on univariable analysis. Median MELD at LT was consistently higher in all regions for BMI ≥40 with 4 regions showing a higher rate of waitlist dropout. Using BRFSS data, the proportion of listed patients with BMI ≥40 versus the rate of morbid obesity in the adult population was lower in three regions (Table 2). The range of listing median calculated MELD for the three regions with a lower proportion vs higher proportion of listed patients with BMI ≥40 was 27.5-37 and 25-37 respectively.
*Conclusions: Careful patient selection can ameliorate the modestly lower post-LT patient survival for BMI ≥40. It is necessary to further explore the causes of regional variations in listing of high BMI patients as well as the causes behind the higher waitlist dropout rates.
To cite this abstract in AMA style:Lian T, Kaur N, Emamaullee J, Lo M, Ender P, Kahn J, Sher L. Transplant Outcomes, Risk Factors, and Regional Variation in Selection of Morbidly Obese Liver Transplant Candidates in the US [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/transplant-outcomes-risk-factors-and-regional-variation-in-selection-of-morbidly-obese-liver-transplant-candidates-in-the-us/. Accessed October 29, 2020.
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