Obese and Normal Weight Patients Do Equally Well After Liver Transplantation

Barry Schlansky, M.D., M.P.H Assistant Professor of Medicine Oregon Health & Science University

Dr. Schlansky

MedicalResearch.com Interview with:
Barry Schlansky, M.D., M.P.H
Assistant Professor of Medicine
Oregon Health & Science University

Medical Research: What are the main findings and significance of this study?

Dr. Schlansky: This study examines how obese patients fare before and after liver transplantation. Similar to other researchers, we found that obese patients do just as well as normal weight patients after liver transplantation. We were surprised, however, to find that very obese patients died more often while on the wait list before liver transplant.

Medical Research: What should clinicians take away? 

Dr. Schlansky: In a national study of liver transplant outcomes, we found that very obese patients have excellent outcomes after liver transplantation, but surprisingly die more frequently while waiting for transplant. Our study revealed that obese patients benefit more from liver transplantation than lower weight patients, and suggest we should consider lowering weight restrictions for patients who are otherwise good candidates for liver transplant. 

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Schlansky:    We are interested in looking more closely into why very obese patients died more frequently before receiving liver transplantation. This kind of research may benefit patients who are not waiting for liver transplantation, but are simply obese with severe liver disease.

MedicalResearch:  Can you explain why patients who are morbidly obese gain a greater survival benefit from liver transplantation?

Dr. Schlansky:    Patients with end-stage liver disease in general greatly benefit from liver transplantation, usually measured in terms of extra years of life. Survival benefit compares how likely a patient is to die before getting a transplant to how likely they are to die after a transplant. Survival benefit is highest for the sickest patients who then get a therapy like liver transplantation that significantly lengthens their lives. In our study, we found that very obese patients are more likely then lower weight patients to die while waiting for a liver transplant, but have the same likelihood as normal weight patients of dying after receiving a transplant. Thus, very obese patients gain more survival benefit from liver transplantation.

MedicalResearch:  Do you foresee a policy change or least a start of a dialogue? 

Dr. Schlansky:   No national policy exists for liver transplantation based on body weight. However, most U.S. liver transplant centers follow general recommendations that recommend against transplanting very obese patients. We hope our research will open the possibility for centers to consider liver transplantation for very obese patients who are otherwise good candidates.

MedicalResearch:  What are the implications for the field of liver transplantation?

Dr. Schlansky:    Obesity brings unique challenges to liver transplantation, such as increased risks of diabetes, heart and kidney disease. The liver transplant community will have to learn how to better deal with these issues if we begin transplanting more obese patients.

MedicalResearch:  Was there anything that surprised you about the result of this study? 

Dr. Schlansky:    Other researchers have previously shown that obese patients do well after liver transplantation.  We did not expect to find that very obese patients died more often while on the wait list before transplantation.

Citation:

AASLD abstract presented at the Liver Meeting®, held in San Francisco, CA,
November 14-17 2015

Liver transplant outcomes and survival benefit for obese patients in the United States: Are we disadvantaging the morbidly obese?

Barry Schlansky, M.D., M.P.H (2015). Obese and Normal Weight Patients Do Equally Well After Liver Transplantation

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