Patients who are considerably obese or underweight before liver transplantation happens are at a greater risk of dying following the transplantation surgery as per a recent study by doctors at the University of Washington.

The findings of this study were published in the August issue of Liver Transplantation, a journal published by John Wiley & Sons on behalf of the American Association for the Study of Liver Diseases.

From News-Medical.Net:

After transplantation, the very severely obese patients experienced higher rates of death due to infectious complications and cancer. The authors propose that one mechanism for this apparent immune deficiency is the presence of diabetes in patients with BMI > 40 kg/m2. Previous studies show that diabetic patients are at increased risk of infectious complications after surgical procedures, and supplemental immunosuppressive medication may further exacerbate this process. “An appropriate weight-based immunosuppressive regimen, careful management of severely obese patients’ co-morbidities (diabetes, hypertension) and aggressive facilitation of weight reduction can optimize the health of these patients and potentially improve patient outcomes,” suggest the researchers.

For patients who are severely obese, past protocol was to resolve their co-morbidities and help them achieve weight loss prior to transplantation. “A better approach might be to transplant these patients sooner by not requiring weight loss or working with the United Network for Organ Sharing (UNOS) for a policy change to assign additional Model for End-Stage Liver Disease (MELD) points for severe obesity, as is done for patients with hepatocellular carcinoma,” concluded the authors. “Aggressive management of the patients’ co-morbid factors and posttransplantation weight loss is a must.” The researchers also recommend a posttransplantation immunosuppressive regimen favoring less immunosuppressive medications without steroids and low dose tacrolimus based on the ideal body weight.

The involved researchers suggested a more aggressive immunosuppressive regimen with higher doses of mycophenolate mofetil and tacrolimus so that patients can be provided with great relief.