Singing the obesity blues in liver transplantation for hepatocellular carcinoma

Here is my latest highlight from the journal HPB

Obesity is a global problem and fatty liver disease is one of many consequences of the changing waistlines of society. The association between obesity and development of non-alcoholic fatty liver disease and cirrhosis, in its own right or as a cofactor for other diseases, has been long known. Similarly the association with hepatocellular carcinoma (HCC) is well documented.

In this edition of HPB, Mathur and colleagues from Florida explore the outcomes of their patients undergoing liver transplantation for HCC in relation to obesity. They found higher postoperative complication rates and length of stay in overweight patients in keeping with other studies. The novel finding of this study was the association between obesity and the higher incidence of recurrence of HCC, which also occurred more rapidly, compared with non-obese patients. The authors argue that obesity may be an adverse factor for outcome in liver transplantation for HCC and the doubling of the hazard ratio which they observed would support this.

Whether this information will alter the listing behaviours of centres remains to be seen but I suspect a larger cohort will need to be studied to provide corroboration. This paper, along with other studies indicating high rates of cardiovascular events after liver transplantation in obese patients, also raises the question of whether there is a role for bariatric surgery or other weight loss measures to try and improve outcomes of this group after the major resource investment that is liver transplantation.

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