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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jun 18, 2015; 7(11): 1484-1493
Published online Jun 18, 2015. doi: 10.4254/wjh.v7.i11.1484
“Weighing the risk”: Obesity and outcomes following liver transplantation
Trevor W Reichman, George Therapondos, Maria-Stella Serrano, John Seal, Rachel Evers-Meltzer, Humberto Bohorquez, Ari Cohen, Ian Carmody, Emily Ahmed, David Bruce, George E Loss
Trevor W Reichman, George Therapondos, Maria-Stella Serrano, John Seal, Rachel Evers-Meltzer, Humberto Bohorquez, Ari Cohen, Ian Carmody, Emily Ahmed, David Bruce, George E Loss, Multi-Organ Transplant Institute, Ochsner Medical Center, New Orleans, LA 70121, United States
Author contributions: Reichman TW and Evers-Meltzer R collected and analyzed papers for the review; Reichman TW, Therapondos G and Serrano MS wrote the paper; Seal J, Bohorquez H, Cohen A, Carmody I, Ahmed E, Bruce D and Loss GE were responsible for the critical revision of the manuscript.
Conflict-of-interest: The authors have no conflicts of interest related to this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Trevor W Reichman, MD, PhD, Multi-organ Transplant Institute, Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA 70121, United States. treichman@ochsner.org
Telephone: +1-504-8423925 Fax: +1-504-8425746
Received: November 29, 2014
Peer-review started: November 29, 2014
First decision: January 20, 2015
Revised: February 23, 2015
Accepted: April 10, 2015
Article in press: April 14, 2015
Published online: June 18, 2015
Processing time: 199 Days and 6.5 Hours
Abstract

Obesity is on the rise worldwide. As a result, unprecedented rates of patients are presenting with end stage liver disease in the setting of non-alcoholic fatty liver disease (NAFLD) and are requiring liver transplantation. There are significant concerns that the risk factors associated with obesity and the metabolic syndrome might have a detrimental effect on the long term outcomes following liver transplantation. In general, short term patient and graft outcomes for both obese and morbidly obese patients are comparable with that of non-obese patients, however, several studies report an increase in peri-operative morbidity and increased length of stay. Continued studies documenting the long-term outcomes from liver transplantation are needed to further examine the risk of recurrent disease (NAFLD) and also further define the role risk factors such cardiovascular disease might play long term. Effective weight reduction in the post liver transplant setting may mitigate the risks associated with the metabolic syndrome long-term.

Keywords: End stage liver disease; Obesity; Morbid obesity; Non-alcoholic steatohepatitis; Non-alcoholic fatty liver disease; Cirrhosis; Liver transplantation

Core tip: Cirrhosis in the setting of obesity especially from non-alcoholic fatty liver disease is quickly becoming one of the leading indications for liver transplantation. These patients present unique challenges both at the time of transplant and long term secondary to chronic illnesses associated with the metabolic syndrome. Outcomes following liver transplantation and management of these patients will be discussed in light of the current available literature.