Retrospective Cohort Study
Copyright ©The Author(s) 2022.
World J Gastroenterol. Jul 14, 2022; 28(26): 3218-3231
Published online Jul 14, 2022. doi: 10.3748/wjg.v28.i26.3218
Table 1 Pre-liver transplant clinical and laboratory variables
Total (n = 176)BMI groups after ascites correction
P value
Overweight or obese (n = 122)
Underweight or normal (n = 54)
Age at listing, median (range) years61.0 (32.0–71.4)60.3 (32.0–71.4)61.6 (45.2–71.0)0.048a
Age at end of listing, median (range) years61.0 (32.0–72.0)61.0 (32.0–71.0)62.0 (48.0–72.0)0.09
Female sex, n (%)81 (46.02)53 (43.44)28 (51.85)0.30
Height at listing, median (range) cm168.0 (148.0–193.0)168.0 (148.0–188.0)168.0 (150.0–193.0)0.23
Weight at listing, median (range) kg88.3 (39.6–146.5)94.9 (69.0–146.5)72.0 (39.6–94.2)< 0.001c
Ascites adjusted weight at listing, median (range) kg77.4 (33.7–140.0)85.1 (60.5–140.0)64.4 (33.7–80.1)< 0.001c
Weight at end of listing, median (range) kg86.9 (39.6–161.8)92.9 (50.7–161.8)73.9 (39.6–94.2)< 0.001c
BMI at listing, median (range) kg/m231.0 (17.6–48.9)33.7 (25.6–48.9)25.4 (17.6–30.8)< 0.001c
Ascites adjusted BMI at listing, median (range) kg/m227.4 (15.0–45.3)29.2 (25.0–45.3)22.6 (15.0–24.9)< 0.001c
Na MELD (at listing), median (range)22.0 (10.0–48.0)21.0 (11.0–48.0)22.0 (10.0–43.0)0.34
Na MELD at end of listing, median (range)23.0 (6.0–45.0)23.0 (6.0–44.0)23.0 (10.0–45.0)0.41
Creatinine at listing, median (range) μmol/L98.5 (51.0–564.0)96.5 (55.0–564.0)103.0 (51.0–399.0)0.50
Creatinine at end of listing, median (range) μmol/L112.5 (44.0–719.0)115.0 (44.0–719.0)109.0 (49.0–483.0)0.50
eGFR at listing, median (range) mL/min/1.73 m263.0 (17.0–120.0)65.5 (18.0–117.0)56.0 (17.0–120.0)0.11
eGFR at end of listing, median (range) mL/min/1.73 m252.5 (17.0–116.0)57.0 (17.0–116.0)48.0 (20.0–98.0)0.017a
Bilirubin at listing, median (range) μmol/L49.0 (8.0–955.0)51.0 (8.0–755.0)45.5 (14.0–955.0)0.11
Bilirubin at end of listing, median (range) μmol/L56.5 (3.0–927.0)58.0 (8.0–927.0)50.0 (3.0–802.0)0.19
INR at listing, median (range)1.5 (1.1–4.7)1.5 (1.1–4.7)1.5 (1.1–3.9)0.05
INR at end of listing, median (range)1.7 (1.1–7.6)1.7 (1.1–7.6)1.8 (1.1–5.0)0.46
Na at listing, median (range) mEq/L134.0 (116.0–147.0)135.0 (120.0–147.0)133.0 (116.0–142.0)0.014a
Na at end of listing, median (range) mEq/L135.0 (116.0–159.0)135.0 (116.0–159.0)134.0 (120.0–152.0)0.10
Albumin at listing, median (range) g/L30.5 (9.0 – 47.0)29.5 (20.0–47.0)31.0 (9.0–42.0)0.08
Albumin at end of listing, median (range) g/L30.0 (10.0–54.0)30.0 (12.0–54.0)30.0 (10.0–50.0)0.28
Frailty score (n = 159), median (range)4.0 (2.0–8.0)4.0 (2.0–8.0)5.0 (3.0–8.0)0.25
None to mild, n (%)116 (72.96)78 (71.56)38 (76)0.56
Moderate to severe, n (%)43 (27.04)31 (28.44)12 (24)
Missing, n (%)17 (9.66)13 (10.66)4 (7.41)
Encephalopathy, n (%)141 (80.11)99 (81.15)42 (77.78)0.61
Ascites, n (%)161 (91.48)109 (089.34)052 (096.30)0.15
Degree of ascites, n (%)
None14 (07.95)13 (10.66)1 (1.85)0.030a
Mild41 (23.30)30 (24.59)11 (20.37)
Moderate30 (17.05)24 (019.67)6 (11.11)
Severe91 (51.70)55 (45.08)36 (66.67)
Need for LVP, n (%)103 (58.86)64 (52.89)39 (72.22)0.016a
SBP, n (%)46 (26.44)33 (27.05)13 (25.00)0.78
Variceal bleed, n (%)53 (30.11)34 (27.87)19 (35.19)0.33
Hepatorenal syndrome, n (%)48 (27.27)30 (24.59)18 (33.33)0.23
Hypertension, n (%)80 (45.45)58 (47.54)22 (40.74)0.40
Diabetes, n (%)104 (59.09)68 (55.74)36 (66.67)0.17
Hyperlipidemia, n (%)57 (32.39)35 (28.69)22 (40.74)0.12
CKD, n (%)18 (10.23)12 (9.84)6 (11.11)0.80
CAD, n (%)29 (16.48)22 (18.03)7 (12.96)0.40
Time on waiting list, median (range) days136.0 (1.0–1566.0)139.5 (1.0–1497.0)117.0 (1.0–1566.0)0.42
ICU stay within 90 d before end of listing, n (%)30 (17.05)21 (17.21)9 (16.67)0.93
No of hospitalizations within 90 d before end of listing, median (range), n (%)1.0 (0.0–5.0)1.0 (0.0–5.0)1.0 (0.0–5.0)0.42
< 2151 (85.80)105 (86.07)46 (85.19)0.88
≥ 225 (14.20)17 (13.93)8 (14.81)
Bacteraemia/sepsis within 90 d before end of listing, n (%)19 (11.66)12 (10.62)7 (14.00)0.54
Outcome, n (%)
Active living1 (0.57)1 (0.82)0 (00)0.26
De-listed22 (12.50)14 (11.48)8 (14.81)
Died42 (23.86)25 (20.49)17 (31.48)
Transplanted111 (63.07)82 (67.21)29 (53.70)
Type of LT received, n (%)
DDLT78 (70.27)57 (69.51)21 (72.41)0.77
LDLT33 (29.73)25 (30.49)8 (27.59)
Table 2 Percentage of patients who changed body mass index groups after ascites correction
Reduction in BMI after ascites correction
Original/uncorrected
Unchanged
Underweight
Normal
Overweight
Obesity 1
Obesity 2
Underweight, 2 (1.1%)2 (100%)
5 (22.73%)Normal, 22 (12.5%)17 (77.27%)
29 (55.77%)Overweight, 52 (29.55%)23 (44.23%)
1 (1.82%)42 (76.36%)Obesity 1, 55 (31.25%)12 (21.82%)
17 (62.96%)Obesity 2, 27 (15.34%)10 (37.04%)
2 (11.11%)11 (61.11%)Obesity 3, 18 (10.23%)5 (27.78%)
All BMI group had some level of decrease after correctionEspecially higher BMI groups have more % reductionTotal (n = 176)% of unchanged are higher among low BMI groups
Table 3 Post transplant outcomes
Total (n = 111)BMI after ascites correction
P value
Overweight or obese (n = 82)
Underweight or normal (n = 29)
Biliary stricture, n (%)22 (19.8)16 (19.5)6 (20.7)0.97
Biliary leak, n (%)10 (9)7 (8.5)3 (10.3)1.0
Hepatic artery thrombosis, n (%)2 (1.8)0 (0)2 (6.9)0.07
90-d re-hospitalization (n = 103), n (%)23 (22.3)17 (22.6)6 (21.4)0.89
Recurrent NAFLD, n (%)57 (51.4)44 (53.7)13 (44.8)0.59
Time to recurrent NAFLD, median (range) days568 (13–2135)489 (13–1821)757 (80–2135)0.21
Recurrent NASH, n (%)7 (6.3)5 (6.1)2 (6.9)1.0
Time to recurrent NASH, median (range) days812 (363–1119)802 (363–1119)957.5 (812–1103)0.28
BMI at 1 yr (n = 83), median (range) kg/m230.3 (19.2–44.0)31.7 (23.2–44.0)26.1 (19.2–34.2)< 0.001c
BMI at 5 yr (n = 17), median (range) kg/m233.9 (20.3–47.9)35.1 (26.6 – 47.9)27.0 (20.3–31.5)0.004b
Creatinine at 1 yr (n = 70), median (range) μmol/L114.0 (54.0–279.0)117.5 (63.0–279.0)106.0 (54.0–178.0)0.21
Creatinine at 5 yr (n = 19), median (range) μmol/L143.0 (67.0-257.0)153.5 (78.0–257.0)111.0 (67.0–127.0)0.019a
Diabetes at 1 yr (n = 82), n (%)36 (43.9)27 (45.8)9 (39.1)0.59
Diabetes at 5 yr (n = 20), n (%)10 (50)8 (53.3)2 (40)0.72
Hypertension at 1 yr (n = 83), n (%)44 (53)33 (55)11 (47.8)0.56
Hypertension at 5 yr (n = 20), n (%)12 (60)10 (66.7)2 (40)0.35
Cardiovascular events post LT, n (%)22 (19.8)14 (17)8 (27.6)0.45
Fibroscan Elastography (n = 48), median (range) kPa6.4 (2.3–21.8)6.8 (3.5–21.8)4.8 (2.3–14.5)0.011a
Fibroscan CAP (n = 48), median (range) dB/m286.5 (181.0–400.0)298.0 (198.0–400.0)283.5 (181.0–400.0)0.26
Graft loss within 90 d post LT, n (%)5 (4.5)1 (1.2)4 (13.8)0.032a
Graft survival post LT 1 yr (n = 101), n (%)94 (93.1)72 (98.6)22 (78.6)0.002b
Graft survival post LT 3 yr (n = 72), n (%)65 (90.3)48 (96)17 (77.3)0.025a
Graft survival post LT 5 yr (n = 32), n (%)22 (68.8)17 (85)5 (41.7)0.018a
Deaths post LT, n (%)7 (6.3)2 (2.4)5 (17.2)0.029a
Time to death post LT (n = 7), median (range) days224 (13–1176)192.5 (20–365)224 (13–1176)0.42
Death within 90 d post-LT, n (%)2 (1.8)1 (1.2)1 (3.4)0.38
Patient survival at 1 yr (n = 108), n (%)104 (96.3)78 (98.7)26 (89.7)0.06
Patient survival at 3 yr (n = 97), n (%)66 (91.7)48 (96)18 (81.8)0.07
Patient survival at 5 yr (n = 32), n (%)25 (78.1)18 (90)7 (58.3)0.07