Postoperative morbidity, mortality, costs, and long-term survival in severely obese patients undergoing orthotopic liver transplantation

OBJECTIVE: Severely obese patients who undergo orthotopic liver transplanta tion are likely to have higher morbidity, mortality, costs, and a lower lon g-term survival. METHODS: This case-control study was done at a university hospital. One hun dred twenty-one consecutive patients who underwent liver transplantation be tween 1994 and 1996 were studied. Severe obesity was defined as body mass i ndex (BMI) more than 95th percentile (>32.3 for women and >31.1 for men), a nd moderate obesity was defined as BMI between 27.3 and 32.3 for women and 27.8 and 31.1 for men. The outcome measures were intraoperative complicatio ns, postoperative complications (wound infections, bile leak, vascular comp lications), length of hospital stay, costs of transplantation, and long-ter m survival RESULTS: The baseline characteristics, UNOS status, and cause of liver dise ase at the time of transplantation were similar in severely obese (n = 21, BMI = 37.4 +/- 4.8 kg/m(2)), obese (n = 36, BMI 28.7 +/- 0.9 kg/m(2)), and nonobese patients (n = 64, BMI 23.8 +/- 2.5 kg/m(2)). The intraoperative co mplications and transfusion requirements were similar in all three groups. The postoperative complications such as respiratory failure (p = 0.009) and systemic vascular complications (p = 0.04) were significantly higher in se verely obese patients. The overall perioperative complication rate was 0.61 (39 of 64 patients) in nonobese patients, 0.77 (28 of 36 patients) in obes e patients, and 1.43 (30 of 21 patients) in severely obese patients (p = 0. 01). Infections were the leading cause of death in all groups accounting fo r 57-66% of deaths. The length of hospital stay was significantly higher in obese patients. The hospital costs of transplantation were higher ($30,000 -$40,000) in severely obese patients than in nonobese patients. The long-te rm patient survival was similar between the group (Kaplan-Meier analysis). CONCLUSIONS: Despite higher postoperative complications, severely obese pat ients have an acceptable long-term survival, which is comparable to nonobes e patients. The cost of transplantation is higher among severely obese pati ents. There was no increased incidence of cardiovascular mortality among se verely obese patients during the follow-up period. (C) 2001 by Am. Cell. of Gastroenterology.