The impact of sex and body mass index in liver transplantation for acute-on-chronic liver failure.

IF 3.2 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Journal of Hepato‐Biliary‐Pancreatic Sciences Pub Date : 2024-12-27 DOI:10.1002/jhbp.12100

Miho Akabane, Yuki Imaoka, Toshihiro Nakayama, Carlos O Esquivel, Kazunari Sasaki

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Abstract

Background/purpose: There have been no studies evaluating how body mass index (BMI) impacts on waitlist and post-liver transplant (LT) mortality in acute-on-chronic liver failure (ACLF) by sex. We aimed to determine these impacts using the United Network for Organ Sharing (UNOS) database.

Methods: Adults listed for LT with estimated ACLF (Est-ACLF) (2005-2023) were identified and subdivided by sex and BMI (high/middle/low). Competing-risk analyses evaluated impacts on waitlist mortality. Kaplan-Meier analyses assessed post-LT survival. Multivariable Cox regression identified risk factors.

Results: Of 37 251 Est-ACLF patients, 14 534 (39.0%) were female. Females had higher 90-day waitlist mortality than males (subhazard ratio [sHR]: 1.20, p < .01). High/low BMI patients had higher mortality than middle (sHR: 1.08/1.11, p < .01). In females, high BMI was associated with higher mortality than low (sHR: 1.10, p = .02); in males, low BMI was associated with higher mortality than high/middle (sHR: 1.16/1.16 vs. high/middle, p < .01). Multivariable analyses showed in females, high BMI was a significant risk factor for waitlist mortality (sHR:1.21, p < .01), while low was not; in males, high/low BMI was significant, with low having higher sHR (1.17) than high (1.09). Post-LT survival showed no significant difference in females; in males, low BMI showed worse post-3-/5-year-LT survival (p < .01). Multivariable Cox regression showed for females, neither low nor high BMI was significant for post-LT survival; for males, low BMI was significant for 1-/3-/5-year-LT survival (HR: 1.30/1.30/1.22, p < .01).

Conclusions: Our analysis of BMI's impact on LT outcomes in ACLF by sex enables risk stratification and provides a basis for adjusting BMI.

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性别和体重指数对急性和慢性肝衰竭肝移植的影响。

背景/目的：目前尚无研究评估体重指数（BMI）对急性慢性肝衰竭（ACLF）患者等待名单和肝移植后（LT）死亡率的性别影响。我们的目的是利用联合器官共享网络（UNOS）数据库来确定这些影响。方法：对列有估计ACLF （Est-ACLF）的LT成人（2005-2023）进行鉴定，并按性别和BMI（高/中/低）细分。竞争风险分析评估了对候选名单死亡率的影响。Kaplan-Meier分析评估了肝移植后的生存。多变量Cox回归确定了危险因素。结果：37 251例Est-ACLF患者中，女性14 534例（39.0%）。女性的90天等候期死亡率高于男性（亚危险比[sHR]: 1.20, p）。结论：我们分析了BMI对ACLF患者LT结局的影响，并按性别进行了风险分层，为调整BMI提供了依据。

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来源期刊

Journal of Hepato‐Biliary‐Pancreatic Sciences GASTROENTEROLOGY & HEPATOLOGY-SURGERY

自引率

10.00%

发文量

178

审稿时长

6-12 weeks

期刊介绍： The Journal of Hepato-Biliary-Pancreatic Sciences (JHBPS) is the leading peer-reviewed journal in the field of hepato-biliary-pancreatic sciences. JHBPS publishes articles dealing with clinical research as well as translational research on all aspects of this field. Coverage includes Original Article, Review Article, Images of Interest, Rapid Communication and an announcement section. Letters to the Editor and comments on the journal’s policies or content are also included. JHBPS welcomes submissions from surgeons, physicians, endoscopists, radiologists, oncologists, and pathologists.