P2354 - Assessing Liver Transplant Outcomes in Lean vs Non-Lean NAFLD Patients

Manesh Kumar Gangwani, MD¹, Umar Hayat, MD², Muhammad Aziz, MD¹, Yusuf Nawras, ¹, Dushyant Singh. Dahiya, MD³, Anooja Rani, ⁴, Abeer Aziz, MD⁵, Faisal Kamal, MD^6
1University of Toledo, Toledo, OH; ²Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA; ³University of Kansas School of Medicine, Kansas City, KS; ⁴Dow University of Health Sciences, Karachi, Sindh, Pakistan; ⁵University of Augusta, Augusta, GA; ⁶Thomas Jefferson Health, Philadephia, PA

Introduction: Non-alcoholic steatohepatitis (NASH), a severe manifestation of non-alcoholic fatty liver disease (NAFLD), is the second leading indication for liver transplantation (LT). Current evidence in various studies regarding BMI (lean < 25 kg/m2, non-lean >25 kg/m2) and transplant outcomes is mixed. Therefore, we aim to assess the effect of pre-transplant BMI of NAFLD/NASH patients on mortality and graft survival.

Methods: A systemic search was conducted from electronic databases (PubMed/Medline, Cochrane Library, and Google Scholar) from inception to April 2023. All statistical analyses were conducted in Review Manager 5.4.1. Studies meeting inclusion criteria were selected. A random-effect model was used when heterogeneity was seen to pool the studies, and the result was reported in the Odds Ratio (OR)]and the corresponding 95% confidence interval (CI). We also used a narrative approach for qualitative assessment where it was not feasible to quantitatively assess the outcome due to incompatible analytical outputs.

Results: 11 observational studies were used in this study. Pooled results showed no statistically significant relationship between lean and non-lean BMI for post-transplantation mortality in 1 year (OR= 0.78 [95% CI 0.15, 4.01]; p= 0.76; I2= 81%), 2 year (OR= 0.83 [95% CI 0.62, 1.13]; p= 0.24; I2= 57%) and 5 year (OR= 1.07 [95% CI 0.87, 1.31]; p= 0.51; I2= 38%). There was also no statistically significant relation between lean and non-lean with graft survival, observed over 30 days (OR= 1.34 [95% CI 0.79, 2.26]; p= 0.27), 1 year (OR= 0.75 [95% CI 0.46, 1.22]; p= 0.25; I2= 24%), 2 years (OR= 1.20 [95% CI 0.75, 1.91]; p= 0.45; I2= 76%) and 5 years (OR= 1.07 [95% CI 0.84, 1.35]; p= 0.60; I2= 0%). The qualitative analysis indicated a higher rate of mortality and graft rejection in obese individuals but had high heterogeneity and variations in independent studies, limiting interpretability.

Discussion: This pooled statistical analysis determined no statistical difference in mortality or graft survival in lean vs non-lean patients undergoing LT suggesting BMI is not a significant predictor of long-term outcomes. More studies with multivariate regression analysis are needed for higher-powered analysis.



Disclosures:


Manesh Kumar Gangwani, MD¹, Umar Hayat, MD², Muhammad Aziz, MD¹, Yusuf Nawras, ¹, Dushyant Singh. Dahiya, MD³, Anooja Rani, ⁴, Abeer Aziz, MD⁵, Faisal Kamal, MD⁶. P2354 - Assessing Liver Transplant Outcomes in Lean vs Non-Lean NAFLD Patients, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.