Liver Transplantation in the Obese Cirrhotic Patient
| Autor: | Helen S. Te, Archita P. Desai, Anjana Pillai, Daniel Ganger, Jacqueline G. O'Leary, Abdullah M. S. Al-Osaimi, Jennifer C. Lai, Erin Spengler, Shari S. Rogal, James N. Fleming, Georgios Tsoulfas, Anil B. Seetharam, Martin I. Montenovo |
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| Rok vydání: | 2017 |
| Předmět: |
Liver Cirrhosis
Time Factors medicine.medical_treatment Health Status Bariatric Surgery Comorbidity 030230 surgery Liver transplantation Cardiovascular Medical and Health Sciences Oral and gastrointestinal Body Mass Index 0302 clinical medicine Postoperative Complications Weight loss Risk Factors Medicine Adiposity education.field_of_study Liver Disease Graft Survival Stroke Treatment Outcome Infectious Diseases 030211 gastroenterology & hepatology Zero Hunger medicine.symptom Risk assessment medicine.medical_specialty Waiting Lists Population Chronic Liver Disease and Cirrhosis Risk Assessment Article End Stage Liver Disease 03 medical and health sciences Weight Loss Humans Obesity Intensive care medicine education Metabolic and endocrine Nutrition Transplantation business.industry Wound dehiscence Prevention Organ Transplantation medicine.disease Liver Transplantation Surgery business Digestive Diseases Body mass index Risk Reduction Behavior |
| Zdroj: | Transplantation, vol 101, iss 10 |
| Popis: | Despite the rapidly increasing prevalence of obesity in the transplant population, the optimal management of obese liver transplant candidates remains undefined. Setting strict body mass index cutoffs for transplant candidacy remains controversial, with limited data to guide this practice. Body mass index is an imperfect measure of surgical risk in this population, partly due to volume overload and variable visceral adiposity. Weight loss before transplantation may be beneficial, but it remains important to avoid protein calorie malnutrition and sarcopenia. Intensive lifestyle modifications appear to be successful in achieving weight loss, though the durability of these interventions is not known. Pretransplant and intraoperative bariatric surgeries have been performed, but large randomized controlled trials are lacking. Traditional cardiovascular comorbidities are more prevalent in obese individuals and remain the basis for pretransplant cardiovascular evaluation and risk stratification. The recent US liver transplant experience demonstrates comparable patient and graft survival between obese and nonobese liver transplant recipients, but obesity presents important medical and surgical challenges during and after transplant. Specifically, obesity is associated with an increased incidence of wound infections, wound dehiscence, biliary complications and overall infection, and confers a higher risk of posttransplant obesity and metabolic syndrome-related complications. In this review, we examine current practices in the obese liver transplant population, offer recommendations based on the currently available data, and highlight areas where additional research is needed. |
| Databáze: | OpenAIRE |
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