Featured Research

from universities, journals, and other organizations

Extreme BMI Cause For Concern In Liver Transplantation: Underweight And Severely Obese Patients At Risk

Date:
August 4, 2009
Source:
Wiley - Blackwell
Summary:
A recent study explained that patients who are significantly underweight or very severely obese prior to liver transplantation are at increased risk of death following transplantation surgery.

A recent study by doctors at the University of Washington explained that patients who are significantly underweight or very severely obese prior to liver transplantation are at increased risk of death following transplantation surgery. These findings, from the largest known observation of liver transplantation at the extremes of BMI, are published in the August issue of Liver Transplantation.

Related Articles


The research team led by Andrι A. S. Dick, M.D., Department of Surgery, Division of Transplantation, University of Washington investigated the impact of pre-transplantation Body Mass Index (BMI) on post-liver transplantation patient survival. The doctors hypothesized that individuals at the extremes of BMI were at increased risk of death following liver transplantation. In this study, patients with BMI < 18.5 kg/m2 were in the underweight group, with 1,827 transplanted, while those with BMI ≥ 40 kg/m2 were designated very severely obese, with 1,447 transplanted. Patients with BMI between 18.5 – 40 kg/m2 were assigned to a control group (68,172 patients) because they had similar survival rates.

When compared with the control group, the underweight patients had a higher retransplantation rate due to graft failure and were more likely to die from hemorrhagic complications or cerebrovascular accidents. Previous studies in Japan and Korea have shown a relationship between low BMI (< 18.5kg/m2) and increased risk of fatal strokes in the study populations. The authors of this study stated, “These patients should either be screened in the evaluation phase or be given special vigilance in the posttransplantation period to prevent strokes.”

After transplantation, the very severely obese patients experienced higher rates of death due to infectious complications and cancer. The authors propose that one mechanism for this apparent immune deficiency is the presence of diabetes in patients with BMI > 40 kg/m2. Previous studies show that diabetic patients are at increased risk of infectious complications after surgical procedures, and supplemental immunosuppressive medication may further exacerbate this process. “An appropriate weight-based immunosuppressive regimen, careful management of severely obese patients’ co-morbidities (diabetes, hypertension) and aggressive facilitation of weight reduction can optimize the health of these patients and potentially improve patient outcomes,” suggest the researchers.

For patients who are severely obese, past protocol was to resolve their co-morbidities and help them achieve weight loss prior to transplantation. “A better approach might be to transplant these patients sooner by not requiring weight loss or working with the United Network for Organ Sharing (UNOS) for a policy change to assign additional Model for End-Stage Liver Disease (MELD) points for severe obesity, as is done for patients with hepatocellular carcinoma,” concluded the authors. “Aggressive management of the patients’ co-morbid factors and posttransplantation weight loss is a must.” The researchers also recommend a posttransplantation immunosuppressive regimen favoring less immunosuppressive medications without steroids and low dose tacrolimus based on the ideal body weight.

In patients who are underweight the authors recommend “close follow-up with a nutritionist. If the patients are unable to meet their caloric intake prior to transplantation, they should then be admitted to the hospital for aggressive nutritional supplementation such as tube feedings. This aggressive regimen is continued after transplantation.” The doctors also suggest a more aggressive immunosuppressive regimen with higher doses of tacrolimus and mycophenolate mofetil.


Story Source:

The above story is based on materials provided by Wiley - Blackwell. Note: Materials may be edited for content and length.


Journal Reference:

  1. Dick et al. Liver transplantation at the extremes of the body mass index. Liver Transplantation, 2009; 15 (8): 968 DOI: 10.1002/lt.21785

Cite This Page:

Wiley - Blackwell. "Extreme BMI Cause For Concern In Liver Transplantation: Underweight And Severely Obese Patients At Risk." ScienceDaily. ScienceDaily, 4 August 2009. <www.sciencedaily.com/releases/2009/08/090804071816.htm>.
Wiley - Blackwell. (2009, August 4). Extreme BMI Cause For Concern In Liver Transplantation: Underweight And Severely Obese Patients At Risk. ScienceDaily. Retrieved November 25, 2014 from www.sciencedaily.com/releases/2009/08/090804071816.htm
Wiley - Blackwell. "Extreme BMI Cause For Concern In Liver Transplantation: Underweight And Severely Obese Patients At Risk." ScienceDaily. www.sciencedaily.com/releases/2009/08/090804071816.htm (accessed November 25, 2014).

Share This


More From ScienceDaily



More Health & Medicine News

Tuesday, November 25, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

From Popcorn To Vending Snacks: FDA Ups Calorie Count Rules

From Popcorn To Vending Snacks: FDA Ups Calorie Count Rules

Newsy (Nov. 25, 2014) — The US FDA is announcing new calorie rules on Tuesday that will require everywhere from theaters to vending machines to include calorie counts. Video provided by Newsy
Powered by NewsLook.com
Daily Serving Of Yogurt Could Reduce Risk Of Type 2 Diabetes

Daily Serving Of Yogurt Could Reduce Risk Of Type 2 Diabetes

Newsy (Nov. 25, 2014) — Need another reason to eat yogurt every day? Researchers now say it could reduce a person's risk of developing type 2 diabetes. Video provided by Newsy
Powered by NewsLook.com
Madagascar Working to Contain Plague Outbreak

Madagascar Working to Contain Plague Outbreak

AFP (Nov. 24, 2014) — Madagascar said Monday it is trying to contain an outbreak of plague -- similar to the Black Death that swept Medieval Europe -- that has killed 40 people and is spreading to the capital Antananarivo. Duration: 00:42 Video provided by AFP
Powered by NewsLook.com
Are Female Bosses More Likely To Be Depressed?

Are Female Bosses More Likely To Be Depressed?

Newsy (Nov. 24, 2014) — A new study links greater authority with increased depressive symptoms among women in the workplace. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
 
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:  

Breaking News:

Strange & Offbeat Stories

 

Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:  

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile iPhone Android Web
Follow Facebook Twitter Google+
Subscribe RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins