A0468 - Impact of Cardiovascular Disease on Liver Transplant Candidacy During Transplant Evaluation in a North American Center With High Obesity Prevalence

Nimy John, MD, Cody J. Timmermann, MD, Yash Shah, MD, Matthew G. Deneke, MD, Mary Rude, MD, Ragesh B. Thandassery, MD, DM
University of Arkansas for Medical Sciences, Little Rock, AR

Introduction: There are no large studies that examined the impact of obesity and cardiovascular disease in patients undergoing evaluation for orthotopic liver transplantation (OLT)

Methods: We retrospectively analyzed patients undergoing OLT evaluation between Jan 2012 and Nov 2021 in a liver transplant center in the Mid-West US

Results: 912 patients underwent OLT evaluation (59% males, mean age 57.4±10.5 years, Mean Na-MELD 18.7±8.7, 82% Caucasian and 8.6% African Americans) etiology of cirrhosis NASH (48.1%), alcohol (37.7%), and hepatitis C (18.5%). 31.8% and 41.7% were overweight and obese respectively. 261 (31.8%) underwent OLT, 554 (60.7%) were denied listing, and 51(5.6%) died during evaluation. 224 patients had coronary artery disease (CAD) and among them, 50% were denied OLT. Of all patients denied listing, 32% were denied OLT due to CAD. Comorbid medical conditions (30%), substance use (15%) and socioeconomic condition (19.3%) were other causes for denial for listing. 239 (26.2%) had metabolic syndrome (MS), of which 143 (59.8%) were denied OLT. Among patients denied, 55(10%) were morbidly obese (BMI >40). Gender, residential location(urban v/s rural), hypertension, diabetes, CAD, BNP levels, atrial fibrillation, chronic kidney disease, hyperlipidemia,MS,6-minute walk test (6MWT) did not correlate with transplant denial on univariate analysis (table 1). Ethnicity (African American, p=0.03), vitamin-D deficiency (< 30 ng/ml) and BMI (p=0.038) had significant correlation. On multivariate analysis (MVA), BMI >30), (OR 0.71 [0.51-0.98], p = 0.04) and vitamin-D deficiency (OR 0.21 (0.15-0.29), p < .01) were independent predictors of denial. For predicting death during OLT evaluation, on univariate analysis, 6-minute walk test (6MWT), estimated pulmonary artery pressure (PAP) on transthoracic echocardiography, mean PAP on right heart catheterization, significant coronary obstruction on left heart catheterization were not predictors, but female gender and vitamin-D deficiency were predictors.

On stratified analysis of patients denied listing due to CAD, the presence of MS (OR 2.1(1.3-3.5), p=0.003) was an independent predictor of denial, and normal BNP levels (< 100pg/ml) lowered the risk of denial (OR 0.42 (0.20-0.88), p=0.02).

Discussion: Obesity (BMI >40) and vitamin-D deficiency increased the risk of denial for transplant listing. Presence of metabolic syndrome increased the risk of denial for listing due to CAD and normal BNP levels (< 100pg/ml) significantly lowered the risk of denial from CAD



Disclosures:


Nimy John, MD, Cody J. Timmermann, MD, Yash Shah, MD, Matthew G. Deneke, MD, Mary Rude, MD, Ragesh B. Thandassery, MD, DM. A0468 - Impact of Cardiovascular Disease on Liver Transplant Candidacy During Transplant Evaluation in a North American Center With High Obesity Prevalence, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.