Morbid Obesity and Liver Transplant

Background: The progressive increase in the prevalence of morbid obesity (MO) in the general population is a pressing issue. This rise in MO has also been observed in patients with liver disease who are candidates for liver transplantation (LT).

Methods: A retrospective study of a single-center series was conducted to analyze the impact of MO on morbidity, mortality, and patient survival after LT.

Results: Fifteen patients with a body mass index (BMI) of ≥ 40 kg/m² (mean 40.4 ± 2.99 SD) were transplanted from 2004 to 2023. Thirteen were 13 men (87%) and 2 women (13%), with a mean age of 55 years (±9). The most common indication for LT was liver cirrhosis (93%: 6 alcohol related, 4 hepatitis C virus [HCV] related, and 3 from other causes), and only one case was due to hepatocellular carcinoma in a non-cirrhotic liver (7%). The median stay in the Intensive Care Unit was 5 days (range 2-52), with a median total hospital stay of 15 days (range 10-103). Five patients had a major complication each (≥ IIIa on the Clavien-Dindo scale): liver re-transplantation due to primary graft failure, reoperation due to hemoperitoneum, late superior mesenteric vein (SMV) thrombosis, acute renal failure that required hemodialysis, and surgical wound infection that required drainage. The only patient who required urgent re-transplantation (7%) had an adequate subsequent recovery without other complications. None of the patients underwent obesity surgery pre-, post-, or concurrently with the LT. Patient and graft survival after 5 years was 97%.

Conclusions: In our experience, the outcomes of LT in patients with MO were satisfactory in terms of postoperative morbimortality, as well as in patient survival. Therefore, we do not support the notion of considering MO as a contraindication for LT.