Ochoa-Allemant Pedro, Trivedi Hirsh D, Saberi Behnam, Bonder Alan, Fricker Zachary P
Department of Internal Medicine , Yale School of Medicine , New Haven , Connecticut , USA.
Liver Center, Division of Gastroenterology, Hepatology, and Nutrition, Beth Israel Deaconess Medical Center , Harvard Medical School , Boston , Massachusetts , USA.
Liver Transpl. 2023 Feb 1;29(2):145-156. doi: 10.1002/lt.26531. Epub 2023 Jan 17.
Lean individuals with nonalcoholic fatty liver disease (NAFLD) represent a subset of patients with a distinct risk factor profile. We assessed the association between body mass index (BMI) on waitlist and postliver transplantation (LT) outcomes among these patients. We retrospectively analyzed the United Network for Organ Sharing data, including adult patients with NAFLD listed for LT between February 27, 2002, and June 30, 2020. We first used competing risk analyses to estimate the association of BMI with waitlist removal due to death or clinical deterioration. We then conducted Kaplan-Meier estimates and Cox regression models to determine the impact of weight change during the waiting list on all-cause mortality and graft failure after LT. Patients with normal weight (BMI 18.5-24.9 kg/m 2 ) suffered higher waitlist removal (adjusted subdistribution hazard ratio 1.26, 95% confidence interval [CI] 1.10-1.43; p = 0.001) compared with patients with obesity class I (BMI 30-34.9 kg/m 2 ). Those who remained at normal weight had higher all-cause mortality (adjusted hazard ratio [aHR] 1.61, 95% CI 1.32-1.96; p <0.001) and graft failure (aHR 1.57, 95% CI 1.32-1.88; p <0.001) than patients with stable obesity. Among patients with normal weight, those with the greatest weight increase (BMI gain ≥3 kg/m 2 ) had lower all-cause mortality (aHR 0.55, 95% CI 0.33-0.93; p = 0.03) and graft failure (aHR 0.49, 95% CI 0.30-0.81; p = 0.01) compared with patients with stable weight (BMI change ≤1 kg/m 2 ). Patients with NAFLD with normal weight have increased waitlist removal and those who remained at normal weight during the waitlist period have worse posttransplantation outcomes. Identifying and addressing factors influencing apparent healthy weight prior to LT are crucial to mitigate poor outcomes.
患有非酒精性脂肪性肝病（NAFLD）的瘦人是具有独特风险因素特征的患者亚组。我们评估了这些患者等待名单上的体重指数（BMI）与肝移植（LT）后结局之间的关联。我们回顾性分析了器官共享联合网络的数据，包括2002年2月27日至2020年6月30日期间列入LT名单的成年NAFLD患者。我们首先使用竞争风险分析来估计BMI与因死亡或临床恶化而从等待名单中移除之间的关联。然后，我们进行了Kaplan-Meier估计和Cox回归模型，以确定等待名单期间体重变化对LT后全因死亡率和移植物失败的影响。与I类肥胖患者（BMI 30-34.9 kg/m²）相比，体重正常（BMI 18.5-24.9 kg/m²）的患者等待名单移除率更高（调整后的亚分布风险比1.26，95%置信区间[CI] 1.10-1.43；p = 0.001）。那些体重保持正常的患者全因死亡率（调整后的风险比[aHR] 1.61，95% CI 1.32-1.96；p <0.001）和移植物失败率（aHR 1.57，95% CI 1.32-1.88；p <0.001）高于稳定肥胖患者。在体重正常的患者中，体重增加最大（BMI增加≥3 kg/m²）的患者与体重稳定（BMI变化≤1 kg/m²）的患者相比，全因死亡率（aHR 0.55，95% CI 0.33-0.93；p = 0.03）和移植物失败率（aHR 0.49，95% CI 0.30-0.81；p = 0.01）更低。体重正常的NAFLD患者等待名单移除率增加，且在等待名单期间体重保持正常的患者移植后结局更差。识别和解决LT前影响明显健康体重的因素对于减轻不良结局至关重要。
