Division of Hepatology, Sandra Atlas Bass Center for Liver Diseases, Northshore University Hospital, Northwell Health, Manhasset, NY.
Department of Medicine, Division of Hepatology, Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Manhasset, NY.
Liver Transpl. 2020 Jan;26(1):68-79. doi: 10.1002/lt.25672.
Morbid obesity is considered a relative contraindication for liver transplantation (LT). We investigated if body mass index (BMI; lean versus obese) is a risk factor for post-LT graft and overall survival in nonalcoholic steatohepatitis (NASH) and non-NASH patients. Using the United Network for Organ Sharing (UNOS) database, LT recipients from January 2002 to June 2013 (age ≥18 years) with follow-up until 2017 were included. The association of BMI categories calculated at LT with graft and overall survival after LT were examined. After adjusting for confounders, all obesity cohorts (overweight and class 1, class 2, and class 3 obesity) among LT recipients for NASH had significantly reduced risk of graft and patient loss at 10 years of follow-up compared with the lean BMI cohort. In contrast, the non-NASH group of LT recipients had no increased risk for graft and patient loss for overweight, class 1, and class 2 obesity groups but had significantly increased risk for graft (P < 0.001) and patient loss (P = 0.005) in the class 3 obesity group. In this retrospective analysis of the UNOS database, adult recipients selected for first LT and NASH patients with the lowest BMI have the worse longterm graft and patient survival as opposed to non-NASH patients where the survival was worse with higher BMI.
病态肥胖被认为是肝移植（LT）的相对禁忌症。我们研究了体重指数（BMI；瘦与肥胖）是否是非酒精性脂肪性肝炎（NASH）和非 NASH 患者 LT 后移植物和总体存活率的危险因素。使用美国器官共享网络（UNOS）数据库，纳入了 2002 年 1 月至 2013 年 6 月（年龄≥18 岁）接受 LT 并随访至 2017 年的 LT 受者。检查了 LT 时计算的 BMI 类别与 LT 后移植物和总体存活率之间的关系。在调整混杂因素后，与瘦 BMI 队列相比，NASH 患者中所有肥胖队列（超重和 1 类、2 类和 3 类肥胖）在 10 年随访时的移植物和患者丢失风险明显降低。相比之下，非 NASH 组的 LT 受者超重、1 类和 2 类肥胖组的移植物和患者丢失风险没有增加，但 3 类肥胖组的移植物（P<0.001）和患者丢失（P=0.005）风险显著增加。在这项对 UNOS 数据库的回顾性分析中，选择进行首次 LT 的成年受者和 BMI 最低的 NASH 患者的长期移植物和患者存活率最差，而 BMI 较高的非 NASH 患者的存活率更差。
