Early weight changes after liver transplantation significantly impact patient and graft survival

Background and aim Associations between pre-liver transplantation (pre-LT) BMI and post-LT survival are well described; however, there are few data assessing the associations between the commonly observed post-LT BMI changes and survival. We investigated the impact of early post-LT BMI change on post-LT patient and graft survival. Methods Using United Network for Organ Sharing data, we identified 2968 adult primary LT recipients who were not overweight pre-LT (BMI >16 to ≤25 kg/m²), and who had BMI recorded at 2 years post-LT. Delta BMI was defined as the BMI difference between pre-LT and 2 years post LT. Recipients were grouped into three categories: BMI gain (increase by >1 BMI point), BMI loss (decrease by > 1 BMI point), and BMI stable (maintained BMI within 1 point). Associations between delta BMI and patient and graft survival were evaluated using Kaplan-Meier and multivariable Cox regression analyses. Results BMI gain was common (54%) and associated with significantly greater 5-year patient and graft survival (90 and 89%, respectively), compared with recipients who had either BMI loss (77 and 74%, respectively, P<0.0001 for both) or were BMI stable (83%, P= 0.04 and 82%, P=0.007, respectively). In multivariable analyses, increasing delta BMI was found to be inversely associated with risk for death and graft loss [hazard ratio 0.89 (95% confidence interval 0.86-0.91), P< 0.001; and hazard ratio 0.88 (95% confidence interval 0.86-0.91), P<0.001, respectively]. Conclusion This study of a large national liver transplant database demonstrated that post-LT BMI gain was associated with better patient and graft survival, whereas BMI loss was associated with reduced patient and graft survival. Eur J Gastroenterol Hepatol 28:107-115.