Yüksek vücut kitle indeksi, sağ lob canlı donörden karaciğer nakli alıcılarında postoperatif kanama ve safra komplikasyon oranlarını artıran bir faktör mü?

Abstract

Amaç: Yüksek Vücut Kitle İndeksi, karaciğer transplantasyonu için önemli bir perioperatif ve postoperatif risk faktörü olarak ortaya çıkmaktadır. Karaciğer transplantasyonu alıcılarında artmış BMI'nin perioperatif takip parametreleri ve postoperatif komplikasyonlar üzerine etkisini incelemeyi amaçladık. Gereç ve yöntem: Son dönem karaciğer sirozu nedeniyle canlı vericiden karaciğer nakli yapılan 172 hasta çalışmaya dahil edildi. Bunlara göre soğuk iskemi süresi, operasyon süresi, kan ürünü transfüzyon oranları, hastane yatış süresi, safra komplikasyonları, hepatik ven trombozu, portal ven trombozu, NASH etiyolojisi, postoperatif kanama, sepsis ve primer greft disfonksiyonu arasında fark olup olmadığı BMI'sı 25 ve üzeri olan ve 25'in altında olan kişiler açısından istatistiksel olarak analiz edildi. Bulgular: BMI >25 olan hastalarda anhepatik faz süresi (p=0,047) ve soğuk iskemi süresi (p=0,009) istatistiksel olarak daha uzundu. Sonuç: Uzamış anhepatik faz ve soğuk iskemi süreleri, artan vücut kitle indeksinin postoperatif greft sağ kalımına etkisi açısından önemli olabilir.

Keywords

• Obezite
• vücut kitle indeksi
• karaciğer
• transplantasyon
• komplikasyon

Is high body mass index a factor that increases postoperative hemorrhage and bile complication rates in right lobe living donor liver transplant recipients?

Abstract

Purpose: High Body Mass Index emerges as an important perioperative and postoperative risk factor for liver transplantation. We aimed to examine the effect of increased BMI on perioperative follow-up parameters and per-postoperative complications in liver transplant recipients. Materials and methods: One hundred and seventy-two patients who underwent living-donor liver transplantation for end stage liver cirrhosis were included in the study. Whether there was a difference between cold ischemia time, operation time, blood product transfusion rates, hospital, biliary complications, hepatic vein thrombosis, portal vein thrombosis, NASH etiology, postoperative hemorrhage, sepsis, and primary graft dysfunction were analyzed statistically in terms of those with a BMI of 25 and above and those below 25. Results: Anhepatic phase duration (p=0.047) and cold ischemia duration (p=0.009) were statistically longer in patients with BMI >25. Conclusion: Prolonged anhepatic phase and cold ischemia times may be important in terms of the effect of increased BMI on postoperative graft survival.

Keywords

• Obesity
• body mass index
• liver
• transplantation
• complication

References

1. 1. Hakeem AR, Cockbain AJ, Raza SS, et al. Increased morbidity in overweight and obese liver transplant recipients: a single-center experience of 1325 patients from the United Kingdom. Liver Transpl 2013;19:551-562. https://doi.org/10.1002/lt.23618
2. 2. Spengler EK, G O'Leary J, Te HS, et al. Liver transplantation in the obese cirrhotic patient. Transplantation 2017;101:2288-2296. https://doi.org/10.1097/TP.0000000000001794
3. 3. Conzen KD, Vachharajani N, Collins KM, et al. Morbid obesity in liver transplant recipients adversely affects longterm graft and patient survival in a single-institution analysis. HPB (Oxford) 2015;17:251-257. https://doi.org/10.1111/hpb.12340
4. 4. Donohoe CL, Feeney C, Carey MF, Reynolds JV. Perioperative evaluation of the obese patient. J Clin Anesth 2011;23:575-586. https://doi.org/10.1016/j.jclinane.2011.06.005
5. 5. Beckmann S, Drent G, Ruppar T, Nikolic N, De Geest S. Body weight parameters are related to morbidity and mortality after liver transplantation: a systematic review and meta-analysis. Transplantation 2019;103:2287-2303. https://doi.org/10.1097/TP.0000000000002811
6. 6. Keeffe EB, Gettys C, Esquivel CO. Liver transplantation in patients with severe obesity. Transplantation 1994;57:309-311.
7. 7. LaMattina JC, Foley DP, Fernandez LA, et al. Complications associated with liver transplantation in the obese recipient. Clin Transplant 2012;26:910-918. https://doi.org/10.1111/j.1399-0012.2012.01669.x
8. 8. Perez Protto SE, Quintini C, Reynolds LF, et al. Comparable graft and patient survival in lean and obese liver transplant recipients. Liver Transpl 2013;19:907-915. https://doi.org/10.1002/lt.23680

9. 9. Schaeffer DF, Yoshida EM, Buczkowski AK, et al. Surgical morbidity in severely obese liver transplant recipients - a single Canadian Centre Experience. Ann Hepatol 2009;8:38-40.
10. 10. Padwal RS, Wang X, Sharma AM, Dyer D. The impact of severe obesity on post-acute rehabilitation efficiency length of stay, and hospital costs. J Obes 2012;2012:972365. https://doi.org/10.1155/2012/972365
11. 11. Dare AJ, Plank LD, Phillips ARJ, et al. Additive effect of pretransplant obesity, diabetes, and cardiovascular risk factors on outcomes after liver transplantation. Liver Transpl 2014;20:281-290. https://doi.org/10.1002/lt.23818
12. 12. Conzen KD, Vachharajani N, Collins KM, et al. Morbid obesity in liver transplant recipients adversely affects long-term graft and patient survival in a single-institution analysis. HPB (Oxford) 2015;17:251-257. https://doi.org/10.1111/hpb.12340
13. 13. LaMattina JC, Foley DP, Fernandez LA, et al. Complications associated with liver transplantation in the obese recipient. Clin Transplant 2012;26:910-918. https://doi.org/10.1111/j.1399-0012.2012.01669.x
14. 14. Alqahtan SA, Brown RS. Management and risks before, during, and after liver transplant in individuals with obesity. Gastroenterol Hepatol (NY) 2023;19:20-29.
15. 15. Soma D, Park Y, Mihaylov P, et al. Liver transplantation in recipients with class III obesity: posttransplant outcomes and weight gain. Transplant Direct 2022;8:e1242. https://doi.org/10.1097/TXD.0000000000001242
16. 16. Fujikawa T, Fujita S, Mizuno S, et al. Clinical and financial impact of obesity on the outcome of liver transplantation. Transplant Proc 2006;38:3612-3614. https://doi.org/10.1016/j.transproceed.2006.10.188
17. 17. Shi Y, Huang B, Deng R, Ma Y. The association of obesity with vascular complications after liver transplantation. BMC Gastroenterology 2019;19:39. https://doi.org/10.1186/s12876-019-0954-8
18. 18. García Fernández N, Cepeda Franco C, Beltrán Miranda P, et al. Body mass index as a prognostic factor in liver transplantation. Transplant Proc 2020;52:1493-1495. https://doi.org/10.1016/j.transproceed.2020.03.008
19. 19. Moctezuma Velazquez C, Márquez Guillén E, Torre A. Obesity in the liver transplant setting. Nutrients 2019;11:2552. https://doi.org/10.3390/nu11112552
20. 20. Hakeem AR, Cockbain AJ, Raza SS, et al. Increased morbidity in overweight and obese liver transplant recipients: a single-center experience of 1325 patients from the United Kingdom. Liver Transpl 2013;19:551-562. https://doi.org/10.1002/lt.23618
21. 21. Sawyer RG, Pelletier SJ, Pruett TL. Increased early morbidity and mortality with acceptable long-term function in severely obese patients undergoing liver transplantation. Clin Transplant 1999;13:126-130. https://doi.org/10.1034/j.1399-0012.1999.130111.x
22. 22. Diaz Nieto R, Lykoudis PM, Davidson BR. Recipient body mass index and infectious complications following liver transplantation. HPB (Oxford) 2019;21:1032-1038. https://doi.org/10.1016/j.hpb.2019.01.002