Obese Patients Face Longer Waits for Liver Transplantation

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> http://www.medscape.com/viewarticle/585504

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> Obese Patients Face Longer Waits for Liver Transplantation

> By Will Boggs, MD

> NEW YORK (Reuters Health) Dec 17 - Obese patients face prolonged waiting times

> for liver transplantation, reflecting a possible " reluctance to transplant

> obese patients, " according to a report in the November issue of the ls of

> Surgery.

> " In transplantation, outcomes are available online to the general public, and

> compared from hospital to hospital, " Dr. Dorry L. Segev from s Hopkins

> University School of Medicine, Baltimore, told Reuters Health. " 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. "

> Dr. Segev and colleagues determined the association between body mass index

> (BMI) and access to transplantation in more than 25,000 consecutive patients,

> using the model for end-stage liver disease exceptions, provider turndowns of

> organ offers, and time-to-transplantation.

> After adjusting for other factors, severely obese patients had 30% lower odds

> and morbidly obese patients had 38% lower odds of receiving model of end-stage

> liver disease exceptions than did nonobese patients, the authors report.

> Similarly, severely obese patients had 10% higher likelihood and morbidly

> obese patients had 16% higher likelihood of being turned down for an organ

> offer.

> Overall, after adjustments for many factors related to transplantation rate,

> severely obese patients had 11% lower rates and morbidly obese patients 29%

> lower rates of being transplanted.

> Among centers listing patients on the waiting list during this study period,

> 11% listed none who were severely obese and 19% listed none who were morbidly

> obese, the investigators report.

> " Our findings suggest a reluctance to perform liver transplantation on obese

> patients, " the authors conclude. " If indeed as a community we feel that liver

> allografts should not be distributed to patients with excessive postoperative

> risk, we should consider expressing this as a formal change to our allocation

> policy rather than through informal practice patterns. "

> " I believe that liver allografts should be allocated fairly to patients who

> are determined by their providers to be good candidates, " Dr. Segev said.

> " Many obese patients are predicted to derive a significant survival benefit

> from liver transplantation. "

> " All patients in our study were already on the waiting list, in other words,

> already determined to be good candidates, " Dr. Segev continued. " I believe

> that there should be no disparities past that hurdle, especially under the

> current allocation scheme which specifically allocates based on disease

> severity score and no other characteristics. "

> Ann Surg 2008;248:863-870.

[Guest guest]

> http://www.medscape.com/viewarticle/585504

>

>

>

>

>

> Obese Patients Face Longer Waits for Liver Transplantation

> By Will Boggs, MD

> NEW YORK (Reuters Health) Dec 17 - Obese patients face prolonged waiting times

> for liver transplantation, reflecting a possible " reluctance to transplant

> obese patients, " according to a report in the November issue of the ls of

> Surgery.

> " In transplantation, outcomes are available online to the general public, and

> compared from hospital to hospital, " Dr. Dorry L. Segev from s Hopkins

> University School of Medicine, Baltimore, told Reuters Health. " 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. "

> Dr. Segev and colleagues determined the association between body mass index

> (BMI) and access to transplantation in more than 25,000 consecutive patients,

> using the model for end-stage liver disease exceptions, provider turndowns of

> organ offers, and time-to-transplantation.

> After adjusting for other factors, severely obese patients had 30% lower odds

> and morbidly obese patients had 38% lower odds of receiving model of end-stage

> liver disease exceptions than did nonobese patients, the authors report.

> Similarly, severely obese patients had 10% higher likelihood and morbidly

> obese patients had 16% higher likelihood of being turned down for an organ

> offer.

> Overall, after adjustments for many factors related to transplantation rate,

> severely obese patients had 11% lower rates and morbidly obese patients 29%

> lower rates of being transplanted.

> Among centers listing patients on the waiting list during this study period,

> 11% listed none who were severely obese and 19% listed none who were morbidly

> obese, the investigators report.

> " Our findings suggest a reluctance to perform liver transplantation on obese

> patients, " the authors conclude. " If indeed as a community we feel that liver

> allografts should not be distributed to patients with excessive postoperative

> risk, we should consider expressing this as a formal change to our allocation

> policy rather than through informal practice patterns. "

> " I believe that liver allografts should be allocated fairly to patients who

> are determined by their providers to be good candidates, " Dr. Segev said.

> " Many obese patients are predicted to derive a significant survival benefit

> from liver transplantation. "

> " All patients in our study were already on the waiting list, in other words,

> already determined to be good candidates, " Dr. Segev continued. " I believe

> that there should be no disparities past that hurdle, especially under the

> current allocation scheme which specifically allocates based on disease

> severity score and no other characteristics. "

> Ann Surg 2008;248:863-870.