Akabane Miho, Imaoka Yuki, Nakayama Toshihiro, Esquivel Carlos O, Sasaki Kazunari
Division of Abdominal Transplant, Department of Surgery, Stanford University Medical Center, Stanford, California, USA.
J Hepatobiliary Pancreat Sci. 2025 Feb;32(2):102-113. doi: 10.1002/jhbp.12100. Epub 2024 Dec 27.
BACKGROUND/PURPOSE: There have been no studies evaluating how body mass index (BMI) impacts on waitlist and post-liver transplant (LT) mortality in acute-on-chronic liver failure (ACLF) by sex. We aimed to determine these impacts using the United Network for Organ Sharing (UNOS) database.
Adults listed for LT with estimated ACLF (Est-ACLF) (2005-2023) were identified and subdivided by sex and BMI (high/middle/low). Competing-risk analyses evaluated impacts on waitlist mortality. Kaplan-Meier analyses assessed post-LT survival. Multivariable Cox regression identified risk factors.
Of 37 251 Est-ACLF patients, 14 534 (39.0%) were female. Females had higher 90-day waitlist mortality than males (subhazard ratio [sHR]: 1.20, p < .01). High/low BMI patients had higher mortality than middle (sHR: 1.08/1.11, p < .01). In females, high BMI was associated with higher mortality than low (sHR: 1.10, p = .02); in males, low BMI was associated with higher mortality than high/middle (sHR: 1.16/1.16 vs. high/middle, p < .01). Multivariable analyses showed in females, high BMI was a significant risk factor for waitlist mortality (sHR:1.21, p < .01), while low was not; in males, high/low BMI was significant, with low having higher sHR (1.17) than high (1.09). Post-LT survival showed no significant difference in females; in males, low BMI showed worse post-3-/5-year-LT survival (p < .01). Multivariable Cox regression showed for females, neither low nor high BMI was significant for post-LT survival; for males, low BMI was significant for 1-/3-/5-year-LT survival (HR: 1.30/1.30/1.22, p < .01).
Our analysis of BMI's impact on LT outcomes in ACLF by sex enables risk stratification and provides a basis for adjusting BMI.
背景/目的：尚无研究评估体重指数（BMI）如何按性别影响慢性肝衰竭急性发作（ACLF）患者在等待肝移植（LT）名单上的死亡率及肝移植后的死亡率。我们旨在利用器官共享联合网络（UNOS）数据库确定这些影响。
确定2005年至2023年被列入LT名单且估计为ACLF（Est-ACLF）的成年人，并按性别和BMI（高/中/低）进行细分。竞争风险分析评估对等待名单死亡率的影响。Kaplan-Meier分析评估肝移植后的生存率。多变量Cox回归确定风险因素。
在37251例Est-ACLF患者中，14534例（39.0%）为女性。女性在等待名单上的90天死亡率高于男性（亚风险比[sHR]：1.20，p < 0.01）。高/低BMI患者的死亡率高于中等BMI患者（sHR：1.08/1.11，p < 0.01）。在女性中，高BMI与高于低BMI的死亡率相关（sHR：1.10，p = 0.02）；在男性中，低BMI与高于高/中等BMI的死亡率相关（sHR：1.16/1.16对比高/中等BMI，p < 0.01）。多变量分析显示，在女性中，高BMI是等待名单死亡率的显著风险因素（sHR：1.21，p < 0.01），而低BMI不是；在男性中，高/低BMI均显著，低BMI的sHR（1.17）高于高BMI（1.09）。肝移植后的生存率在女性中无显著差异；在男性中，低BMI显示肝移植后3/5年生存率较差（p < 0.01）。多变量Cox回归显示，对于女性，低BMI和高BMI对肝移植后的生存率均无显著影响；对于男性，低BMI对肝移植后1/3/5年生存率有显著影响（风险比：1.30/1.30/1.22，p < 0.01）。
我们按性别分析BMI对ACLF患者肝移植结局的影响，能够进行风险分层，并为调整BMI提供依据。
