The prevalence of
obesity is increasing globally, with nearly half of a billion of the world's population now considered to be
overweight or obese.
Obesity and
overweight patients are one of the major health issues in Canada, resulting in approximately 57,000 deaths related to
obesity over the last 15 years. The effect of
obesity on outcomes following
liver transplantation remains largely unclear. To determine the effect of
obesity on outcome we reviewed 167
liver transplants, performed at the Vancouver General Hospital, between February 1999 and October 2003.
Severe obesity was defined as body mass index (BMI) > 35 kg/m2 and moderate
obesity as BMI of 30 - 34 kg/m2. One hundred forty three transplants were performed in patients with a body mass index (BMI) < 30 kg/m2, 14 in patients with a BMI of 30 - 34 kg/m2, and 10 in patients with a BMI > 35 kg/m2. Non-weight related patient demographics were similar between the groups. A very high proportion of Hepatitic C patients (7/10) were observed in the severely obese group. In the early postoperative course severely obese patients had a higher rate of
wound infection (20% vs. 4%, p = 0.0001) and
wound dehiscence (40% vs. 1.2%, p = 0.0001). Within the first twelve postoperative months severely obese
liver transplant recipients had a higher rate of ventral
wound herniation (30% vs. 2.8%, p = 0.0001) when compared to obese or non-obese recipients. The one-year graft and patient survival were similar to non-obese patients. An increased BMI in
liver transplant recipients in our centre did not increase the risk of early postoperative mortality, but did increase surgical complications, such as
wound infection and
wound dehiscence. The 1-year patient and graft survival however was indistinguishable from those of non-obese patients.