Wiley Logo Obesity now seems to play a major role in mortality of children subjected to primary liver transplantation (LT). According to a recent study commenced by the University of Washington, overweight kids undergoing LT experience heightened mortality risk in later years. It was claimed that thin or severely thin pediatric patients face an early mortality risk within the first year post-LT.

The ten-year survival analysis reviewed data from the Organ Procurement and Transplantation Network (OPTN). It was mentioned that 7,942 patients below the age of 18 years with full BMI data went through primary liver transplantation between 1987 and 2007. On the basis of the WHO BMI criteria, patients were grouped as severely thin, thin, normal weight, overweight, or obese. A total of 61 percent patients fell into the category of normal weight. After a year considerably lower survival of 84 percent was reported by thin or severely thin kids and 89 percent by children in the normal and overweight groups.

Andre Dick, M.D., from Seattle Children’s Hospital and the University of Washington and lead author of the study, said, “Controversies exist regarding the mortality of patients undergoing liver transplantation at the extremes of body mass index (BMI), and in pediatric patients weight is typically the only factor considered in survival analysis. Our study is the largest thus far to report on the impact of pre-transplant BMI on post liver transplant survival in the pediatric population.”

No dramatic variation in survival during the first year after transplantation for obese pediatric patients appeared. By the twelfth year post LT a survival of 72 percent was registered by the obese group and 77 percent by normal weight or overweight pediatric patients. It was concluded that obesity has a significantly negative impact on pediatric patient survival more than five years after LT. It is suspected that post metabolic syndrome (PTMS) is involved in late morbidity and mortality due to time consumption for long-term obesity-related conditions, namely diabetes, hypertension, and hyperlipidemia.

The effects of PTMS may be worsened because of long-term immunosuppressive therapy usage after transplantation aimed to boost patient survival. Further investigations can be undertaken for analyzing the precise immunosuppressive regimen that can decline PTMS effects. Scientists assume that pre- and post-transplant identification of malnourished or obese pediatric patients together with optimization of risk factors can best use scarce donor organs and expand patient survival.

The study is published in the November issue of Liver Transplantation.