Outcomes in liver transplant recipients with and without obesity: A propensity-matched analysis using the TriNetX database.

Abstract

e23096 Background: Obesity is a growing concern among liver transplant recipients and has been linked to adverse post-transplant outcomes. This study aims to shed light on the impact of obesity on liver transplant outcomes. Methods: This retrospective cohort study leveraged the TriNetX database to evaluate the impact of obesity on outcomes in liver transplant recipients. Propensity score matching was applied to control for confounding demographic and clinical variables such as age, gender, and comorbidities, ensuring balanced comparison groups for analysis. Results: After 1:1 propensity score matching, a total of 18323 patients were identified in the Liver Transplant without obesity group and 18308 patients in the Liver Transplant with obesity group. Before propensity matching, significant differences were observed between the 2 groups. Obese recipients were older (61.5 years vs. 58.2 years, p < 0.001) and more likely to have comorbidities, such as hypertensive diseases (67.6% vs. 24.8%, p < 0.001), ischemic heart diseases (28.3% vs. 9.3%, p < 0.001), and asthma (11.2% vs. 3.2%, p < 0.001). Additionally, the obese group included more females (40.6% vs. 37.2%, p < 0.001). After matching, baseline characteristics were well-balanced between the groups. Mean age was 61.0 years (obese) and 61.2 years (non-obese, p = 0.199), and gender distribution was nearly identical (39.1% female in the obese group vs. 38.4% in the non-obese group, p = 0.210). Comorbidities such as hypertensive diseases (61.3% vs. 61.2%, p = 0.882) and ischemic heart disease (23.3% vs. 22.5%, p = 0.065) were also comparable. Obese recipients demonstrated significantly higher odds of adverse outcomes. Liver transplant rejection was more likely in obese recipients (OR 1.191, CI 1.127–1.258, p < 0.001), as were transplant failure (OR 1.149, CI 1.074–1.229, p < 0.001) and transplant-related infection (OR 1.220, CI 1.070–1.391, p = 0.003). Additionally, obesity was associated with increased odds of heart failure (OR 1.459, CI 1.379–1.545, p < 0.001) and acute kidney injury (OR 1.234, CI 1.183–1.286, p < 0.001). Conclusions: Obesity significantly increases the risks of rejection, failure, infection, heart failure, and acute kidney injury in liver transplant recipients, even after controlling for baseline differences through propensity matching. These findings underscore the importance of targeted interventions and close monitoring of obese recipients to optimize transplant outcomes. This analysis highlights the value of propensity score matching in isolating the impact of obesity on liver transplant results. Condition Odds Ratio CI Lower Bound CI Upper Bound p-value Liver Transplant Rejection 1.191 1.127 1.258 0.000 Liver Transplant Failure 1.149 1.074 1.229 0.000 Liver Transplant Infection 1.220 1.070 1.391 0.003 Heart Failure 1.459 1.379 1.545 0.000 Acute Kidney Injury 1.234 1.183 1.286 0.000