Liver transplantation in the morbidly obese

Study Objective: To test the hypothesis that morbid obesity implies increased difficulty of liver transplantation and increased risk of adverse outcome. Design: Retrospective review of medical records of 40 morbidly obese patients using a control cohort of patients transplanted just before and after the obese patients. Setting: University medical center. Patients: All morbidly obese patients who underwent liver transplantation over a 52-month period were included. Forty adult patients met criterion for morbid obesity with body mass index greater than 30 kg/m². Records for 61 time-matched controls were reviewed. Measurements and Main Results: Demographic, intraoperative, and postoperative data were collected including preoperative diagnoses, laboratory and pulmonary function tests, intraoperative transfusion requirement sand length of surgery, postoperative complications, and survival. Data were analyzed using Student's t-tests, and Chi-square analyses as appropriate, with significance considered a p-value less than 0.05. Obese patients were more hypoxemic than controls prior to surgery (PaO₂, 82.9 ± 3.5 vs. 93.0 ± 3.0 mmHg), were more likely to be diabetic, and had higher creatinine levels (3.0 ± 0.6 vs. 1.7 ± 0.2 mg/dl). Despite this evidence of multi-organ dysfunction, intraoperative and postoperative pulmonary and cardiac complications did not differ between groups. Though more obese patients had prior cholecystectomy, length of surgery and intraoperative transfusion requirements were not different between groups. Obese patients did not have an increased incidence of reoperation for wound problems, and lengths of intensive care unit and hospital stays did not differ between groups. Graft and patient survival were similar in obese and nonobese liver transplant recipients. Conclusion: Morbid obesity alone does not predispose to increased complications or decreased survival after liver transplantation.