Obese patients wait longer for liver transplant

By Will Boggs, MD

NEW YORK (Reuters Health) - People hoping for a liver transplant and who are obese face prolonged waiting times, reflecting a possible “reluctance to transplant obese patients,” according to a new report.

“In transplantation, outcomes are available online to the general public, and compared from hospital to hospital,” Dr. Dorry L. Segev explained to Reuters Health.

While this transparency may be welcome, “the side effect is that centers might become too reluctant to take on challenging cases, in fear that a bad outcome would be misinterpreted as poor quality of care.”

Segev, from Johns Hopkins University School of Medicine, Baltimore, and colleagues looked into the relationship between body weight and access to transplantation in more than 25,000 consecutive patients.

After adjusting for other factors, severely obese patients had 30 percent lower odds and morbidly obese patients had 38 percent lower odds of getting a priority classification than did non-obese patients, the researchers report in the November issue of the Annals of Surgery.

Similarly, severely obese patients had 10 percent higher likelihood and morbidly obese patients had 16 percent higher likelihood of being turned down for an organ offer.

Among centers posting their waiting lists during this study period, 11 percent listed no patients who were severely obese and 19 percent listed none who were morbidly obese, the investigators report.

“Our findings suggest a reluctance to perform liver transplantation on obese patients,” the authors conclude.

“I believe that liver (grafts) should be allocated fairly to patients who are determined by their providers to be good candidates,” Segev said. “Many obese patients are predicted to derive a significant survival benefit from liver transplantation.”

In fact, Segev concluded, “All patients in our study were already on the waiting list — in other words, already determined to be good candidates. I believe that there should be no disparities past that hurdle.”

SOURCE: Annals of Surgery, November 2008.

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