Obesity and metabolic complications of liver transplantation

Key Points 1. The body mass index is not an adequate measure of obesity in patients with cirrhosis. It is necessary to account for the contributions of ascites and fluid overload in addition to the distribution of adipose tissue. The interpretation of the literature on the effects of the body mass index on posttransplant outcomes is difficult if adjustments are not made for these factors. 2. Survival after liver transplantation has improved over the years and appears unaffected by obesity (even class III obesity) before transplantation. 3. Obesity is even more common after liver transplantation. Weight increases occur, with the greatest gains occurring within the first 6 months of transplant. Education and lifestyle management for the prevention of weight gain are the first measures in the posttransplant management of obesity. 4. Further investigation of bariatric surgery before, during, and after transplantation is needed. 5. Metabolic syndrome and its individual components are common after liver transplantation and are associated with increased risks of cardiovascular disease, cardiovascular death, liver-related deaths, and overall mortality. 6. Recurrent or de novo steatosis in the allograft is not uncommon and is a risk for steatohepatitis and progression to cirrhosis with graft loss. Liver Transpl 16:S65-S71, 2010. copy; 2009 AASLD.