BACKGROUND Short-term survival after orthotopic liver transplantation (OLT) has improved over the past decades, but long-term survival remains impaired. The effects of obesity on long-term survival after OLT are controversial. Because pre-transplant body mass index (BMI) can be confounded by ascites, we hypothesized that post-transplant BMI at 1 year could predict long-term survival. METHODS A post-hoc analysis was performed of an observational cohort study consisting of adult recipients of a first OLT between 1993 and 2010. Baseline BMI was measured at 1-year post-transplantation to represent a stable condition. Recipients were stratified into normal weight (BMI < 25 kg/m2), overweight (25 ≤ BMI ≤ 30 kg/m2), and obese (BMI > 30 kg/m2). Kaplan-Meier survival analyses were performed with log-rank testing, followed by multivariable Cox proportional hazards regression analysis. RESULTS Out of 370 included recipients, 184 had normal weight, 136 were overweight, and 50 were obese at 1-year post-transplantation. After median follow-up for 12.3 years, 107 recipients had died, of whom 46 (25%) had normal weight, 39 (29%) were overweight, and 22 (44%) were obese (log-rank P = 0.020). Obese recipients had a significantly increased mortality risk compared to normal weight recipients (HR 2.00, 95% CI 1.08-3.68, P = 0.027). BMI was inversely associated with 15 years patient survival (HR 1.08, 95% CI 1.03-1.14, P = 0.001 per kg/m2), independent of age, gender, muscle mass, transplant characteristics, cardiovascular risk factors, kidney- and liver function. CONCLUSION Obesity at 1-year post-transplantation conveys a 2-fold increased mortality risk, which may offer potential for interventional strategies (i.e. dietary advice, lifestyle modification, or bariatric surgery) to improve long-term survival after OLT.

中文翻译：

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移植后肥胖会影响肝移植后的长期生存。

背景技术在过去的几十年中，原位肝移植（OLT）后的短期存活率有所提高，但是长期存活率仍然受到损害。肥胖对OLT术后长期生存的影响存在争议。由于移植前的体重指数（BMI）可能与腹水混淆，因此我们假设移植后的BMI在1年时可以预测长期生存。方法对一项观察性队列研究进行事后分析，该研究由1993年至2010年间第一个OLT的成年接受者组成。在移植后1年测量基线BMI，以表明病情稳定。收件人分为正常体重（BMI <25 kg / m2），超重（25≤BMI≤30 kg / m2）和肥胖（BMI> 30 kg / m2）。Kaplan-Meier生存分析采用对数秩检验，然后进行多变量Cox比例风险回归分析。结果在370位接受者中，移植后1年的体重正常者184例，超重者136例，肥胖者50例。中位随访12.3年后，有107位接受者死亡，其中46位（25％）体重正常，39位（29％）超重，22位（44％）肥胖（log-rank P = 0.020）。与正常体重的接受者相比，肥胖的接受者的死亡风险显着增加（HR 2.00，95％CI 1.08-3.68，P = 0.027）。BMI与15年患者生存率成反比（HR 1.08，95％CI 1.03-1.14，P = 0.001每kg / m2），与年龄，性别，肌肉质量，移植特征，心血管危险因素，肾和肝功能无关。结论移植后1年的肥胖使死亡风险增加了2倍，