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Body Weight Parameters are Related to Morbidity and Mortality After Liver Transplantation

A Systematic Review and Meta-analysis

Beckmann, Sonja PhD, RN1,2; Drent, Gerda PhD, RN3; Ruppar, Todd PhD, RN4; Nikolić, Nataša MScN5; De Geest, Sabina PhD, RN1,6

doi: 10.1097/TP.0000000000002811
Original Clinical Science–Liver

Background. Weight gain and obesity are well-known clinical issues in liver transplantation (LTx). However, their impacts on patient outcomes remain unclear, as only the impact of pre-LTx body mass index (BMI) on survival has been meta-analyzed. We summarized and synthesized the evidence on pre- and post-LTx body weight parameters’ relations with post-LTx outcomes such as survival, metabolic and cardiovascular comorbidities, and healthcare utilization.

Methods. We followed the Cochrane Handbook for Systematic Reviews of Interventions’ recommendations. Quality was assessed via a 19-item instrument. Odds ratios and 95% confidence intervals were calculated for outcomes investigated in ≥5 studies.

Results. Our meta-analysis included 37 studies. Patients with pre-LTx BMI ≥ 30 kg/m2 and BMI ≥ 35 kg/m2 had lower overall survival rates than those with pre-LTx normal weight (72.6% and 69.8% versus 84.2%; P = 0.02 and P = 0.03, respectively). Those with pre-LTx BMI ≥ 30 kg/m2 had worse overall graft survival than normal weight patients (75.8% and 85.4%; P = 0.003). Pre-LTx BMI and pre-LTx overweight were associated with new-onset diabetes (P < 0.001 and P = 0.015, respectively), but post-LTx BMI showed no relationship. No associations were evident with healthcare utilization.

Conclusions. Patients with BMI values ≥30 kg/m2 had worse patient and graft survival than those with normal weight. Few of the reviewed studies examined post-LTx body weight parameters or other relevant outcomes such as cardiovascular comorbidities. High heterogeneity as well as diverse definitions and operationalizations of measurement and outcomes severely impeded comparability.

1 Institute of Nursing Science, Department Public Health, University of Basel, Basel, Switzerland.

2 Center of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland.

3 Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, RB Groningen, The Netherlands.

4 Rush University College of Nursing, Chicago, IL.

5 Spitalregion Fürstenland Toggenburg, Wil, Switzerland.

6 Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.

Received 25 January 2019. Revision received 29 April 2019.

Accepted 21 May 2019.

This work was supported by a Research Grant from the International Transplant Nurses Society. The funding source was involved in neither the research nor preparation of the article.

The authors declare no conflicts of interest.

S.B. and S.D.G. participated in the research design, performance of the research, data analysis, and writing of the article. G.D. participated in the research design, performance of the research, data analysis, and reviewing of the article. N.N. participated in the performance of the research and reviewing of the article. T.R. participated in the research design and data analysis. All authors approved the final article.

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (

Correspondence: Sabina De Geest, PhD, Institute of Nursing Science, Department Public Health, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland. (

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.