Morbid obesity is associated with major diseases that can lead to fatal complications. The literature is not only conflicting, but also scarce in studies on liver transplantation in morbidly obese patients. To study the demographics and outcome of liver transplantation in morbidly obese patients at the University of Miami.
A retrospective review of all liver transplant patients with BMI = or >35 Kg/m2 from 1995- 2003. Out of 1255 patients, 99 met the criteria for morbid obesity (43 females and 56 males). 79 patients had BMI of 35-40 kg/m2, while 20 patients had BMI >40. Etiology of liver failure: HCV 44%, Cryptogenic 19%, Laennec’s 10%, NASH 6%, Fulminant hepatic Failure 5%, & other 16%. Retransplantation rate was 9% (3 patients for hepatic artery thrombosis, 3 for primary nonfunction, one for portal vein thrombosis, and one for recurrent HCV). Overall 1, 3, and 5-year patient survival was 86%, 83%, and 81% respectively. Overall 1, 3, and 5-year graft survival was 86%, 83%, and 80%, respectively. Among those who died, 50% of patients with BMI >40 died in the first three months after surgery, while 33% of patients with BMI 35-40 did. Sepsis leading to multiorgan system failure was the major cause of mortality (57%) especially in the early postoperative period (<3 months). One patient died within 3 days post-op due to pulmonary hypertension. Recurrent disease (28%), and MI (9%) were other causes of mortality that occurred late (>6 months). Our data suggest that liver transplantation is an acceptable option for morbidly obese patients requiring such transplantation. Aggressive measures to prevent, or control sepsis in the early postoperative period must be taken as the majority of the mortality occurred during that time. Weight reduction after transplantation should be implemented.