Changes in nutritional status after liver transplantation

World Journal of Gastroenterology

Volumn 20, Issue 31, 2014, Pages 10682-10690

  Giusto, Michela ^a   Lattanzi, Barbara ^a   Di Gregorio, Vincenza ^a   Giannelli, Valerio ^a   Lucidi, Cristina ^a   Merli, Manuela ^a  

^a SAPIENZA UNIVERSITY OF ROME   (Italy)

Author keywords

Liver transplantation; Malnutrition; Metabolic syndrome; Obesity; Outcome; Sarcopenia; Survival

Indexed keywords

CARBOHYDRATE; CORTICOSTEROID; CYCLOSPORIN; DIURETIC AGENT; EVEROLIMUS; FAT; IMMUNOSUPPRESSIVE AGENT; PROTEIN; RAPAMYCIN; TACROLIMUS;

BODY COMPOSITION; BRAIN; CARBOHYDRATE INTAKE; CLINICAL EVALUATION; CORTICOSTEROID THERAPY; DIETARY INTAKE; DUAL ENERGY X RAY ABSORPTIOMETRY; EMBASE; END STAGE LIVER DISEASE; ENERGY METABOLISM; EXERCISE; FAT INTAKE; FAT MASS; GRAFT RECIPIENT; HUMAN; IMMUNOSUPPRESSIVE TREATMENT; INTESTINE; LIVER; LIVER CIRRHOSIS; LIVER GRAFT REJECTION; LIVER TRANSPLANTATION; MALNUTRITION; MEDLINE; METABOLIC DISORDER; MUSCLE FUNCTION; MUSCLE MASS; NUTRITIONAL ASSESSMENT; NUTRITIONAL STATUS; OBESITY; OUTCOME ASSESSMENT; PATIENT COUNSELING; PATIENT MONITORING; PHYSICAL ACTIVITY; POSTOPERATIVE COMPLICATION; PROTEIN INTAKE; REVIEW; RISK FACTOR; SARCOPENIA; SURGICAL RISK; SYSTEMATIC REVIEW; WEIGHT GAIN; ADVERSE EFFECTS; COMPLICATION; LIVER DISEASES; METABOLIC DISEASES; PATHOPHYSIOLOGY; TIME; TREATMENT OUTCOME;

BODY COMPOSITION; HUMANS; LIVER DISEASES; LIVER TRANSPLANTATION; MALNUTRITION; METABOLIC DISEASES; NUTRITIONAL STATUS; OBESITY; RISK FACTORS; SARCOPENIA; TIME FACTORS; TREATMENT OUTCOME; WEIGHT GAIN;

EID: 84909592661     PISSN: 10079327     EISSN: 22192840     Source Type: Journal    
DOI: 10.3748/wjg.v20.i31.10682     Document Type: Review

References (76)

1. Adam R, Karam V, Delvart V, O'Grady J, Mirza D, Klempnauer J, Castaing D, Neuhaus P, Jamieson N, Salizzoni M, Pollard S, Lerut J, Paul A, Garcia-Valdecasas JC, Rodríguez FS, Burroughs A. Evolution of indications and results of liver transplantation in Europe. A report from the European Liver Transplant Registry (ELTR). J Hepatol 2012; 57: 675-688 [PMID: 22609307 DOI: 10.1016/j.jhep.2012.04.015]
2. Wiesner RH, McDiarmid SV, Kamath PS, Edwards EB, Malinchoc M, Kremers WK, Krom RA, Kim WR. MELD and PELD: application of survival models to liver allocation. Liver Transpl 2001; 7: 567-580 [PMID: 11460223 DOI: 10.1053/jlts.2001.25879]
3. Freeman RB, Wiesner RH, Edwards E, Harper A, Merion R, Wolfe R. Results of the first year of the new liver allocation plan. Liver Transpl 2004; 10: 7-15 [PMID: 14755772 DOI: 10.1002/lt.20024]
4. Nutritional status in cirrhosis. Italian Multicentre Cooperative Project on Nutrition in Liver Cirrhosis. J Hepatol 1994; 21: 317-325 [PMID: 7836699]
5. Merli M, Riggio O, Dally L. Does malnutrition affect survival in cirrhosis? PINC (Policentrica Italiana Nutrizione Cirrosi). Hepatology 1996; 23: 1041-1046 [PMID: 8621131]
6. Caregaro L, Alberino F, Amodio P, Merkel C, Bolognesi M, Angeli P, Gatta A. Malnutrition in alcoholic and virus-related cirrhosis. Am J Clin Nutr 1996; 63: 602-609 [PMID: 8599326]
7. Figueiredo FA, De Mello Perez R, Kondo M. Effect of liver cirrhosis on body composition: evidence of significant depletion even in mild disease. J Gastroenterol Hepatol 2005; 20: 209-216 [PMID: 15683423 DOI: 10.1111/j.1440-1746.2004.03544.x]
8. Prijatmoko D, Strauss BJ, Lambert JR, Sievert W, Stroud DB, Wahlqvist ML, Katz B, Colman J, Jones P, Korman MG. Early detection of protein depletion in alcoholic cirrhosis: role of body composition analysis. Gastroenterology 1993; 105: 1839-1845 [PMID: 8253360]
9. Crawford DH, Shepherd RW, Halliday JW, Cooksley GW, Golding SD, Cheng WS, Powell LW. Body composition in nonalcoholic cirrhosis: the effect of disease etiology and severity on nutritional compartments. Gastroenterology 1994; 106: 1611-1617 [PMID: 8194709]
10. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, Martin FC, Michel JP, Rolland Y, Schneider SM, Topinková E, Vandewoude M, Zamboni M. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing 2010; 39: 412-423 [PMID: 20392703 DOI: 10.1093/ageing/afq034]
11. Dasarathy S. Consilience in sarcopenia of cirrhosis. J Cachexia Sarcopenia Muscle 2012; 3: 225-237 [PMID: 22648736 DOI: 10.1007/s13539-012-0069-3]
12. Periyalwar P, Dasarathy S. Malnutrition in cirrhosis: contribution and consequences of sarcopenia on metabolic and clinical responses. Clin Liver Dis 2012; 16 : 95-131 [PMID: 22321468 DOI: 10.1016/j.cld.2011.12.009]
13. Alberino F, Gatta A, Amodio P, Merkel C, Di Pascoli L, Boffo G, Caregaro L. Nutrition and survival in patients with liver cirrhosis. Nutrition 2001; 17: 445-450 [PMID: 11399401 DOI: 10.1016/S0899-9007(01)00521-4]
14. Alvares-da-Silva MR, Reverbel da Silveira T. Comparison between handgrip strength, subjective global assessment, and prognostic nutritional index in assessing malnutrition and predicting clinical outcome in cirrhotic outpatients. Nutrition 2005; 21: 113-117 [PMID: 15723736 DOI: 10.1016/j.nut.2004.02.002]
15. Campillo B, Richardet JP, Bories PN. Validation of body mass index for the diagnosis of malnutrition in patients with liver cirrhosis. Gastroenterol Clin Biol 2006; 30 : 1137-1143 [PMID: 17075467]
16. Peng S, Plank LD, McCall JL, Gillanders LK, McIlroy K, Gane EJ. Body composition, muscle function, and energy expenditure in patients with liver cirrhosis: a comprehensive study. Am J Clin Nutr 2007; 85: 1257-1266 [PMID: 17490961]
17. Huisman EJ, Trip EJ, Siersema PD, van Hoek B, van Erpecum KJ. Protein energy malnutrition predicts complications in liver cirrhosis. Eur J Gastroenterol Hepatol 2011; 23: 982-989 [PMID: 21971339 DOI: 10.1097/MEG.0b013e32834aa4bb]
18. Montano-Loza AJ, Meza-Junco J, Prado CM, Lieffers JR, Baracos VE, Bain VG, Sawyer MB. Muscle wasting is associated with mortality in patients with cirrhosis. Clin Gastroenterol Hepatol 2012; 10: 166-173, 173.e1 [PMID: 21893129 DOI: 10.1016/j.cgh.2011.08.028]
19. Tandon P, Ney M, Irwin I, Ma MM, Gramlich L, Bain VG, Esfandiari N, Baracos V, Montano-Loza AJ, Myers RP. Severe muscle depletion in patients on the liver transplant wait list: its prevalence and independent prognostic value. Liver Transpl 2012; 18: 1209-1216 [PMID: 22740290 DOI: 10.1002/lt.23495]
20. Fernandes SA, Bassani L, Nunes FF, Aydos ME, Alves AV, Marroni CA. Nutritional assessment in patients with cirrhosis. Arq Gastroenterol 2012; 49: 19-27 [PMID: 22481682 DOI: 10.1590/S0004-28032012000100005]
21. Merli M, Giusto M, Lucidi C, Giannelli V, Pentassuglio I, Di Gregorio V, Lattanzi B, Riggio O. Muscle depletion increases the risk of overt and minimal hepatic encephalopathy: results of a prospective study. Metab Brain Dis 2013; 28: 281-284 [PMID: 23224378 DOI: 10.1007/s11011-012-9365-z]
22. Stenholm S, Harris TB, Rantanen T, Visser M, Kritchevsky SB, Ferrucci L. Sarcopenic obesity: definition, cause and consequences. Curr Opin Clin Nutr Metab Care 2008; 11: 693-700 [PMID: 18827572 DOI: 10.1097/MCO.0b013e328312c37d]
23. Tan BH, Birdsell LA, Martin L, Baracos VE, Fearon KC. Sarcopenia in an overweight or obese patient is an adverse prognostic factor in pancreatic cancer. Clin Cancer Res 2009; 15 : 6973-6979 [PMID: 19887488 DOI: 10.1158/1078-0432.CCR-09-1525]
24. Thuluvath PJ. Morbid obesity and gross malnutrition are both poor predictors of outcomes after liver transplantation: what can we do about it? Liver Transpl 2009; 15: 838-841 [PMID: 19642129 DOI: 10.1002/lt.21824]
25. Berzigotti A, Garcia-Tsao G, Bosch J, Grace ND, Burroughs AK, Morillas R, Escorsell A, Garcia-Pagan JC, Patch D, Matloff DS, Groszmann RJ. Obesity is an independent risk factor for clinical decompensation in patients with cirrhosis. Hepatology 2011; 54: 555-561 [PMID: 21567436 DOI: 10.1002/hep.24418]
26. Merli M, Nicolini G, Angeloni S, Riggio O. Malnutrition is a risk factor in cirrhotic patients undergoing surgery. Nutrition 2002; 18: 978-986 [PMID: 12431721]
27. Sheetz KH, Guy K, Allison JH, Barnhart KA, Hawken SR, Hayden EL, Starr JB, Terjimanian MN, Waits SA, Mullard AJ, Krapohl G, Ghaferi AA, Campbell DA, Englesbe MJ. Improving the care of elderly adults undergoing surgery in Michigan. J Am Geriatr Soc 2014; 62: 352-357 [PMID: 24428139 DOI: 10.1111/jgs.12643]]
28. Shahid M, Johnson J, Nightingale P, Neuberger J. Nutritional markers in liver allograft recipients. Transplantation 2005; 79: 359-362 [PMID: 15699770]
29. Owen OE, Trapp VE, Reichard GA, Mozzoli MA, Moctezuma J, Paul P, Skutches CL, Boden G. Nature and quantity of fuels consumed in patients with alcoholic cirrhosis. J Clin Invest 1983; 72: 1821-1832 [PMID: 6630528 DOI: 10.1172/JCI111142]
30. Marchesini G, Bianchi GP, Forlani G, Rusticali AG, Patrono D, Capelli M, Zoli M, Vannini P, Pisi E. Insulin resistance is the main determinant of impaired glucose tolerance in patients with liver cirrhosis. Dig Dis Sci 1987; 32: 1118-1124 [PMID: 3308376]
31. Merli M, Eriksson LS, Hagenfeldt L, Wahren J. Splanchnic and leg exchange of free fatty acids in patients with liver cirrhosis. J Hepatol 1986; 3: 348-355 [PMID: 3559145]
32. Marchesini G, Zoli M, Angiolini A, Dondi C, Bianchi FB, Pisi E. Muscle protein breakdown in liver cirrhosis and the role of altered carbohydrate metabolism. Hepatology 1981; 1: 294-299 [PMID: 7026404 DOI: 10.1002/hep.1840010403]
33. O'Brien A, Williams R. Nutrition in end-stage liver disease: principles and practice. Gastroenterology 2008; 134: 1729-1740 [PMID: 18471550 DOI: 10.1053/j.gastro.2008.02.001]
34. Plank LD, Metzger DJ, McCall JL, Barclay KL, Gane EJ, Streat SJ, Munn SR, Hill GL. Sequential changes in the metabolic response to orthotopic liver transplantation during the first year after surgery. Ann Surg 2001; 234: 245-255 [PMID: 11505071]
35. Merli M, Giusto M, Riggio O, Gentili F, Molinaro A, Attili AF, Ginanni Corradini S, Rossi M. Improvement of nutritional status in malnourished cirrhotic patients one year after liver transplantation. e-SPEN 2011; 6 : e142-e147 [DOI: 10.1016/j.eclnm.2011.02.003]
36. Tsien C, Garber A, Narayanan A, Shah SN, Barnes D, Eghtesad B, Fung J, McCullough AJ, Dasarathy S. Post-liver transplantation sarcopenia in cirrhosis: a prospective evaluation. J Gastroenterol Hepatol 2014; 29: 1250-1257 [PMID: 24443785 DOI: 10.1111/jgh]
37. Keogh JB, Tsalamandris C, Sewell RB, Jones RM, Angus PW, Nyulasi IB, Seeman E. Bone loss at the proximal femur and reduced lean mass following liver transplantation: a longitudinal study. Nutrition 1999; 15: 661-664 [PMID: 10467609]
38. de Carvalho L, Parise ER, Samuel D. Factors associated with nutritional status in liver transplant patients who survived the first year after transplantation. J Gastroenterol Hepatol 2010; 25: 391-396 [PMID: 19929929 DOI: 10.1111/j.1440-1746.2009.06033.x]
39. Richards J, Gunson B, Johnson J, Neuberger J. Weight gain and obesity after liver transplantation. Transpl Int 2005; 18: 461-466 [PMID: 15773968 DOI: 10.1111/j.1432-2277.2004.00067.x]
40. Richardson RA, Garden OJ, Davidson HI. Reduction in energy expenditure after liver transplantation. Nutrition 2001; 17: 585-589 [PMID: 11448577 DOI: 10.1016/S0899-9007(01)00571-8]
41. Ferreira LG, Santos LF, Anastácio LR, Lima AS, Correia MI. Resting energy expenditure, body composition, and dietary intake: a longitudinal study before and after liver transplantation. Transplantation 2013; 96 : 579-585 [PMID: 23851933 DOI: 10.1097/TP.0b013e31829d924e]
42. Anastácio LR, Ferreira LG, de Sena Ribeiro H, Lima AS, Vilela EG, Toulson Davisson Correia MI. Body composition and overweight of liver transplant recipients. Transplantation 2011; 92: 947-951 [PMID: 21869739 DOI: 10.1097/TP.0b013e31822e0bee]
43. Schütz T, Hudjetz H, Roske AE, Katzorke C, Kreymann G, Budde K, Fritsche L, Neumayer HH, Lochs H, Plauth M. Weight gain in long-term survivors of kidney or liver transplantation-another paradigm of sarcopenic obesity? Nutrition 2012; 28: 378-383 [PMID: 22304858 DOI: 10.1016/j.nut.2011.07.019]
44. Wang PY, Caspi L, Lam CK, Chari M, Li X, Light PE, Gutierrez-Juarez R, Ang M, Schwartz GJ, Lam TK. Upper intestinal lipids trigger a gut-brain-liver axis to regulate glucose production. Nature 2008; 452: 1012-1016 [PMID: 18401341 DOI: 10.1038/nature06852]
45. Näslund E, Hellström PM. Appetite signaling: from gut peptides and enteric nerves to brain. Physiol Behav 2007; 92: 256-262 [PMID: 17582445]
46. Rasmussen BA, Breen DM, Lam TK. Lipid sensing in the gut, brain and liver. Trends Endocrinol Metab 2012; 23: 49-55 [PMID: 22169756 DOI: 10.1016/j.tem.2011.11.001]
47. Plevak DJ, DiCecco SR, Wiesner RH, Porayko MK, Wahlstrom HE, Janzow DJ, Hammel KD, O'Keefe SJ. Nutritional support for liver transplantation: identifying caloric and protein requirements. Mayo Clin Proc 1994; 69: 225-230 [PMID: 8133659]
48. Hasse JM, Blue LS, Liepa GU, Goldstein RM, Jennings LW, Mor E, Husberg BS, Levy MF, Gonwa TA, Klintmalm GB. Early enteral nutrition support in patients undergoing liver transplantation. JPEN J Parenter Enteral Nutr 1995; 19: 437-443 [PMID: 8748357]
49. Perseghin G, Mazzaferro V, Benedini S, Pulvirenti A, Coppa J, Regalia E, Luzi L. Resting energy expenditure in diabetic and nondiabetic patients with liver cirrhosis: relation with insulin sensitivity and effect of liver transplantation and immunosuppressive therapy. Am J Clin Nutr 2002; 76: 541-548 [PMID: 12197997]
50. van den Ham EC, Kooman JP, Christiaans MH, Leunissen KM, van Hooff JP. Posttransplantation weight gain is predominantly due to an increase in body fat mass. Transplantation 2000; 70: 241-242 [PMID: 10919614]
51. Mercier JG, Hokanson JF, Brooks GA. Effects of cyclosporine A on skeletal muscle mitochondrial respiration and endurance time in rats. Am J Respir Crit Care Med 1995; 151: 1532-1536 [PMID: 7735611 DOI: 10.1164/ajrccm.151.5.7735611]
52. Sakuma K, Yamaguchi A. The functional role of calcineurin in hypertrophy, regeneration, and disorders of skeletal muscle. J Biomed Biotechnol 2010; 2010: 721219 [PMID: 20379369 DOI: 10.1155/2010/721219]
53. Iadevaia M, Giusto M, Giannelli V, Lai Q, Rossi M, Berloco P, Corradini SG, Merli M. Metabolic syndrome and cardiovascular risk after liver transplantation: a single-center experience. Transplant Proc 2012; 44: 2005-2006 [PMID: 22974893 DOI: 10.1016/j.transproceed.2012.06.022]
54. Gabe SM, Bjarnason I, Tolou-Ghamari Z, Tredger JM, Johnson PG, Barclay GR, Williams R, Silk DB. The effect of tacrolimus (FK506) on intestinal barrier function and cellular energy production in humans. Gastroenterology 1998; 115: 67-74 [PMID: 9649460]
55. Sakuma K, Nakao R, Aoi W, Inashima S, Fujikawa T, Hirata M, Sano M, Yasuhara M. Cyclosporin A treatment upregulates Id1 and Smad3 expression and delays skeletal muscle regeneration. Acta Neuropathol 2005; 110: 269-280 [PMID: 15986223]
56. Miyabara EH, Conte TC, Silva MT, Baptista IL, Bueno C, Fiamoncini J, Lambertucci RH, Serra CS, Brum PC, Pithon-Curi T, Curi R, Aoki MS, Oliveira AC, Moriscot AS. Mammalian target of rapamycin complex 1 is involved in differentiation of regenerating myofibers in vivo. Muscle Nerve 2010; 42: 778-787 [PMID: 20976781 DOI: 10.1002/mus.21754]
57. Gayan-Ramirez G, van de Casteele M, Rollier H, Fevery J, Vanderhoydonc F, Verhoeven G, Decramer M. Biliary cirrhosis induces type IIx/b fiber atrophy in rat diaphragm and skeletal muscle, and decreases IGF-I mRNA in the liver but not in muscle. J Hepatol 1998; 29: 241-249 [PMID: 9722205]
58. Lin SY, Chen WY, Lee FY, Huang CJ, Sheu WH. Activation of ubiquitin-proteasome pathway is involved in skeletal muscle wasting in a rat model with biliary cirrhosis: potential role of TNF-alpha. Am J Physiol Endocrinol Metab 2005; 288: E493-E501 [PMID: 15522995 DOI: 10.1152/ajpendo.00186.2004]
59. Dasarathy S, McCullough AJ, Muc S, Schneyer A, Bennett CD, Dodig M, Kalhan SC. Sarcopenia associated with portosystemic shunting is reversed by follistatin. J Hepatol 2011; 54: 915-921 [PMID: 21145817 DOI: 10.1016/j.jhep.2010.08.032]
60. Merli M, Giusto M, Molfino A, Bonetto A, Rossi M, Ginanni Corradini S, Baccino FM, Rossi Fanelli F, Costelli P, Muscaritoli M. MuRF-1 and p-GSK3β expression in muscle atrophy of cirrhosis. Liver Int 2013; 33: 714-721 [PMID: 23432902 DOI: 10.1111/liv.12128]
61. Krasnoff JB, Vintro AQ, Ascher NL, Bass NM, Paul SM, Dodd MJ, Painter PL. A randomized trial of exercise and dietary counseling after liver transplantation. Am J Transplant 2006; 6: 1896-1905 [PMID: 16889545 DOI: 10.1111/j.1600-6143.2006.01391.x]
62. Millwala F, Nguyen GC, Thuluvath PJ. Outcomes of patients with cirrhosis undergoing non-hepatic surgery: risk assessment and management. World J Gastroenterol 2007; 13: 4056-4063 [PMID: 17696222]
63. Merli M, Giusto M, Giannelli V, Lucidi C, Riggio O. Nutritional status and liver transplantation. J Clin Exp Hepatol Dicembre 2011: 1 n3: 190-198 [DOI: 10.1016/S0973-6883(11)60237-5]
64. Pikul J, Sharpe MD, Lowndes R, Ghent CN. Degree of preoperative malnutrition is predictive of postoperative morbidity and mortality in liver transplant recipients. Transplantation 1994; 57: 469-472 [PMID: 8108888]
65. Selberg O, Böttcher J, Tusch G, Pichlmayr R, Henkel E, Müller MJ. Identification of high- and low-risk patients before liver transplantation: a prospective cohort study of nutritional and metabolic parameters in 150 patients. Hepatology 1997; 25: 652-657 [PMID: 9049214 DOI: 10.1002/hep.510250327]
66. Harrison J, McKiernan J, Neuberger JM. A prospective study on the effect of recipient nutritional status on outcome in liver transplantation. Transpl Int 1997; 10: 369-374 [PMID: 9287402]
67. Figueiredo F, Dickson ER, Pasha T, Kasparova P, Therneau T, Malinchoc M, DiCecco S, Francisco-Ziller N, Charlton M. Impact of nutritional status on outcomes after liver transplantation. Transplantation 2000; 70: 1347-1352 [PMID: 11087151]
68. Stephenson GR, Moretti EW, El-Moalem H, Clavien PA, Tuttle-Newhall JE. Malnutrition in liver transplant patients: preoperative subjective global assessment is predictive of outcome after liver transplantation. Transplantation 2001; 72: 666-670 [PMID: 11544428]
69. de Luis DA, Izaola O, Velicia MC, Sánchez Antolín G, García Pajares F, Terroba MC, Cuellar L. Impact of dietary intake and nutritional status on outcomes after liver transplantation. Rev Esp Enferm Dig 2006; 98: 6-13 [PMID: 16555928]
70. Merli M, Giusto M, Gentili F, Novelli G, Ferretti G, Riggio O, Corradini SG, Siciliano M, Farcomeni A, Attili AF, Berloco P, Rossi M. Nutritional status: its influence on the outcome of patients undergoing liver transplantation. Liver Int 2010; 30: 208-214 [PMID: 19840246 DOI: 10.1111/j.1478-3231.2009.02135.x]
71. Englesbe MJ, Patel SP, He K, Lynch RJ, Schaubel DE, Harbaugh C, Holcombe SA, Wang SC, Segev DL, Sonnenday CJ. Sarcopenia and mortality after liver transplantation. J Am Coll Surg 2010; 211: 271-278 [PMID: 20670867 DOI: 10.1016/j.jamcollsurg.2010.03.039]
72. Englesbe MJ, Lee JS, He K, Fan L, Schaubel DE, Sheetz KH, Harbaugh CM, Holcombe SA, Campbell DA, Sonnenday CJ, Wang SC. Analytic morphomics, core muscle size, and surgical outcomes. Ann Surg 2012; 256: 255-261 [PMID: 22791101 DOI: 10.1097/SLA.0b013e31826028b1]
73. Sawyer RG, Pelletier SJ, Pruett TL. Increased early morbidity and mortality with acceptable long-term function in severely obese patients undergoing liver transplantation. Clin Transplant 1999; 13: 126-130 [PMID: 10081649]
74. Nair S, Verma S, Thuluvath PJ. Obesity and its effect on survival in patients undergoing orthotopic liver transplantation in the United States. Hepatology 2002; 35: 105-109 [PMID: 11786965 DOI: 10.1053/jhep.2002.30318]
75. Dick AA, Spitzer AL, Seifert CF, Deckert A, Carithers RL, Reyes JD, Perkins JD. Liver transplantation at the extremes of the body mass index. Liver Transpl 2009; 15: 968-977 [PMID: 19642131 DOI: 10.1002/lt.21785]
76. Leonard J, Heimbach JK, Malinchoc M, Watt K, Charlton M. The impact of obesity on long-term outcomes in liver transplant recipients-results of the NIDDK liver transplant database. Am J Transplant 2008; 8: 667-672 [PMID: 18294163 DOI: 10.1111/j.1600-6143.2007.02100.x]