Obesity in the Liver Transplant Setting

Area of Science:

• Hepatology
• Transplant Surgery
• Obesity Medicine

Background:

• The global obesity epidemic is driving an increase in obesity among liver transplant (LT) candidates.
• Non-alcoholic fatty liver disease (NAFLD) is the fastest-growing indication for LT, frequently associated with obesity.
• LT teams must understand the unique considerations for managing obese patients undergoing liver transplantation.

Purpose of the Study:

• To outline key aspects of liver transplantation in obese patients.
• To emphasize the importance of cardiovascular risk assessment and perioperative complication prevention.
• To discuss the role of diet, exercise, and bariatric surgery in the context of LT.

Main Methods:

• Review of current literature and clinical considerations for obese LT candidates.
• Analysis of risks including cardiovascular, respiratory, and infectious complications.
• Evaluation of outcomes and treatment strategies, including bariatric surgery.

Main Results:

• Obesity is not an absolute contraindication for LT but necessitates thorough cardiovascular evaluation.
• Obese patients face higher risks of perioperative respiratory and infectious complications, requiring proactive management.
• Long-term patient and graft survival data in obese LT recipients, especially with NAFLD, are limited and suggest potential adverse effects.

Conclusions:

• Obesity management, including diet, exercise, and potentially bariatric surgery, is vital for LT candidates.
• Sleeve gastrectomy shows promise as a bariatric procedure with a favorable safety and efficacy profile in the context of LT.
• Further research is needed to clarify long-term outcomes and optimal timing for interventions in obese LT recipients.