![]() All statistical analyses were performed using SAS version 9.4 (SAS Institute Inc., Cary, NC).ĭetermination of BMI Associated With the Lowest Mortality Rate After LT Statistical significance was evaluated at the 0.05 level. χ 2 Tests were used to examine the statistical significance of the coefficient associated with each covariate.Īll tests are 2-sided. Adapted from the risk-adjustment models published by the Scientific Registry of Transplant Recipients, 23 we included the following covariates: recipient and donor sex, race, BMI at LT (recipient: continuous or categorical), age at LT recipient etiology of liver disease (fulminant, noncholestatic cirrhosis, cholestatic cirrhosis, biliary atresia, metabolic disease, malignant neoplasm 24), status of hepatocellular carcinoma (HCC), hepatitis C, diabetes, hypertension, dialysis before LT, ascites (absent, slight, moderate), medical conditions when treatment was performed (home, inpatient, ICU), international normalized ratio, level of serum albumin, serum creatinine, and total bilirubin at LT, cold ischemia time, human leukocyte antigen mismatch, whether the recipient was on a ventilator, on life support, time-varying graft failure status. When categorical variables were used, an unknown category was created for individuals with missing data.Ĭox proportional hazards models were used in the multivariable analyses. To compare the MELD categories, χ 2 tests were performed to examine differences in proportions for categorical variables, and analysis of variance was conducted to test the differences in means for continuous variables. Additionally, because BMI is a modifiable factor, the results of this study have the potential to inform the waitlisted candidates and their healthcare providers about the optimal BMI associated with the best survival outcomes. The evidence provided by this study can either confirm or revert the current understanding of the association between BMI and posttransplantation survival and inform current clinical practice. The objective of this study is to reexamine the relationship between BMI and post-LT overall survival after the institution of the MELD system and determine the BMI range associated with the highest post-LT survival chance by MELD category. Moreover, obese waitlisted candidates have a longer waiting time for LT and the likelihood of receiving a Model for End-Stage Liver Disease (MELD) exception is 30% to 38% lower than normal-weight candidates. 17, 18 However, many transplant programs decline LT to obese candidates 17 because they have a higher risk of perioperative and postoperative complications 19, 20 and death 3, 4, 6, 9 than nonobese candidates. 15, 16 As a result, the prevalence of obesity in the new LT waitlist registrant population is high. 10 Obesity is associated with elevated risks of morbidity and mortality, 11- 14 including chronic liver disease. More than 1 in 3 US adults are obese (BMI ≥30). Some studies found that LT recipients with extremely low BMI were associated with a higher mortality risk 9 some studies found that obese patients or an elevated BMI were associated with a higher mortality risk, 3, 4, 6, 9 whereas others did not find this association in obese groups. 3- 8 For the latter, there has been continued controversy regarding the association of recipient BMI and posttransplant outcomes, with multiple studies reporting conflicting results. ![]() Studies have shown that risk factors of post-LT mortality include donor age, cold ischemia time, United Network for Organ Sharing urgency status (1, 2A, 2B, or 3), 2 and recipient body mass index (BMI). In 2015, 7127 liver transplants were performed in the United States, making it the second most common solid organ transplant performed in the United States. Liver transplantation (LT) is the definitive treatment for patients with end-stage liver disease.
0 Comments
Leave a Reply. |
Details
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |