Cardiovascular morbidity and obesity in adult liver transplant recipients

Cardiovascular Morbidity and Obesity in Adult Liver Transplant Recipients F. Mazuelos, J. Abril, C. Zaragoza, E. Rubio, J.M. Moreno, V.S. Turrio´n, and V. Cuervas-Mons ABSTRACT There is a direct relationship between the grade of obesity and mortality based on the increased cardiovascular diseases, cancer, etc. However, the results of studies in renal and liver allograft recipients relating obesity to morbidity and mortality are contradictory. A retrospective cohort study of 170 patients transplanted between March 1987 and July 1997 showed obesity to be identified in 77 (45.3%) patients. During the mean follow-up of 5 years posttransplantation, 16 (9.4%) patients experienced cardiovascular complications, including 10 patients with ischemic cardiac syndromes (five acute infarctions and five angina), five patients with acute cerebrovascular accidents, and one patient with intermittent lower limbs claudication. The prevalence of obesity at 1, 3, 5, 7, and 9 years after transplantation was 58.2%, 56.9%, 60.3%, 59.5%, and 66.4%, respectively. Compared with the baseline value, the BMI was increased at 1 year posttransplantation (25.78), a significant difference. No significant differences were found between the mean BMI values of patients with and without cardiovascular diseases, or overweight and morbidly obese patients compared to the normal weight population. Among liver transplant recipients, obesity was a frequent complication after transplantation, but it was not clearly associated with increased morbidity and mortality secondary to cardiovascular disease.

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HERE IS A direct relationship between the grade of obesity and mortality, which is based on cardiovascular diseases, cancer, etc. However, the results of studies in renal and liver allograft recipients relating obesity to morbidity and mortality are contradictory.1–3 The objective of this study was to assess the influence of obesity on morbidity and mortality from cardiovascular disease in liver transplant patients. PATIENTS AND METHODS A retrospective cohort of 170 patients transplanted between March 1987 to July 1997 was stratified based on a body mass index (BMI) higher than 25, which was considered “obese”, with morbid obesity defined as a BMI greater than 30. The BMI was measured at transplantation and subsequently at 1, 3, 5, 7, and 9 years posttransplantation. Mean BMI values were compared between patients with and without cardiovascular events.

RESULTS

The 170 patients included 103 (60.6%) men and 67 (39.4%) women of mean age 45 years (SD 12 years). Obesity was identified in 77 (45.3%) subjects. During the mean follow-up of 5 years posttransplant, 16 (9.4%) patients expe-

rienced cardiovascular complications; 10 patients, ischemic cardiac syndromes including five acute infarctions and five with angina; five patients developed acute cerebrovascular accidents; and one patient, intermittent lower limb claudication. The prevalence of obesity at 1, 3, 5, 7, and 9 years after transplantation was 58.2%, 56.9%, 60.3%, 59.5%, and 66.4%, respectively. BMI was significantly increased at 1 year posttransplantation (25.78) versus the day of transplant. No significant differences were found in the mean BMI of patients with and without cardiovascular disease, or in overweight or morbidly obese patients compared to the normal-weight population. DISCUSSION

Management of obesity in liver transplant recipients is complicated. The causes of postoperative weight gain are From the Departments Medicine (F.M., J.A., C.Z., J.M.M., V.C.M.) and Surgery (E.R., V.S.T.), Liver Transplantation Unit, Hospital Universitario Puerta de Hierro, Universidad Auto´noma, Madrid, Spain. Address reprint requests to E. Rubio Gonzalez, C/ San Martı´n de Porres 4, 28035 Madrid, Spain. E-mail: [email protected]

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Transplantation Proceedings, 35, 1909 –1910 (2003)

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multifactorial, as is also the case with posttransplant diabetes and hyperlipidemia. In four retrospective studies of the impact of obesity on morbidity and mortality among patients undergoing liver transplantation, the presence and degree of obesity was estimated by the widely used BMI (weight (kg)/height(m)2). Although the exact parameters differed between the studies, severely or morbidly obese patients (BMI ⱖ30) accounted for 6.5% to 28% of patients, including over 200 obese or severely obese patients in aggregate. Despite the weight gain exhibited by transplant recipients, it is reassuring to note that the prevalence of obesity at 2 years after surgery was only slightly greater than among the overall age- and gender-matched US population. But in our population obesity showed a lower prevalence. Enrollment in a sensible and carefully designed diet and “exercise program” as well as abstinence from alcohol are commonsense measures. More prophylactic work is needed in these patients, since otherwise obesity and its effects may increase morbidity and mortality.4 – 8

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CONCLUSIONS

Among our liver transplant patients, obesity was a frequent complication, although it was not clearly associated with increased morbidity and mortality secondary to cardiovascular diseases. REFERENCES 1. Modlin C, Flechner S, Goormastic M, et al: Transplantation 64:599, 1997 2. Smith SL: J Transpl Coor 6:178, 1996 3. Stegall M, Everson G, Schroter G, et al: Transplantation 15:1057, 1995 4. Keeffe EB, Gettys C, Esquivel CO, et al: Transplantation 57:309, 1994 5. Braunfeld MY, Chan S, Pregler J, et al: J Clin Anesth 8:585, 1996 6. Sawyer RG, Pelletier J, Pruett TL: Clin Transplant 13:126, 1999 7. Nair S, Cohen DB, Cohen MS, et al: Am J Gastroenterol 96:842, 2001 8. Reuben A: Liver Transpl 7:S13, 2002