Impact of body mass index on outcomes of 48281 patients undergoing first time cadaveric liver transplantation

Table 4 Univariate and multivariate Cox analysis of predictors of overall survival

	Univariate analysis		Multivariate analysis
Variable	Hazard rate (95%CI)	P value	Hazard rate (95%CI)	P value
Recipient BMI		0.003		0.000
Normal weight (reference)	1		1
Underweight	1.125 (1.009-1.255)	0.034	1.265 (1.096-1.461)	0.001
Overweight	1.005 (0.968-1.043)	0.807	0.908 (0.864-0.954)	0.000
Obese class I	1.024 (0.980-1.070)	0.284	0.947 (0.893-1.004)	0.067
Obese class II	1.042 (0.983-1.104)	0.169	0.971 (0.898-1.051)	0.470
Obese class III	1.163 (1.069-1.266)	0.000	1.157 (1.031-1.299)	0.013
Donor BMI		0.001		0.000
Normal weight (reference)	1		1
Underweight	0.962 (0.897-1.033)	0.288	1.017 (0.928-1.114)	0.716
Overweight	1.060 (1.023-1.098)	0.001	1.009 (0.962-1.057)	0.717
Obese class I	1.049 (0.998-1.102)	0.059	0.986 (0.921-1.057)	0.695
Obese class II	1.129 (1.045-1.220)	0.002	1.020 (0.912-1.140)	0.729
Obese class III	0.988 (0.999-1.112)	0.988	0.889 (0.765-1.034)	0.128
Recipient age		0.000		0.000
18-45 (reference)	1		1
46-55	1.264 (1.212-1.319)	0.000	1.207 (1.143-1.276)	0.000
56-65	1.536 (1.471-1.603)	0.000	1.490 (1.405-1.580)	0.000
66-75	2.005 (1.887-2.130)	0.000	2.069 (1.904-2.247)	0.000
≥ 76	3.224 (2.099-4.951)	0.000	2.476 (1.462-4.194)	0.001
Donor age		0.000		0.000
0-17 (reference)	1		1
18-45	1.107 (1.050-1.166)	0.000	1.066 (0.996-1.141)	0.066
46-55	1.297 (1.223-1.376)	0.000	1.266 (1.170-1.370)	0.000
56-65	1.502 (1.411-1.598)	0.000	1.413 (1.300-1.537)	0.000
66-75	1.706 (1.583-1.840)	0.000	1.609 (1.453-1.782)	0.000
≥ 76	1.661 (1.448-1.883)	0.000	1.609 (1.340-1.932)	0.000
Recipient sex (male)	1.063 (1.030-1.097)	0.000	1.025 (0.979-1.073)	0.297
Donor sex (male)	0.951 (0.922-0.980)	0.001	0.967 (0.926-1.008)	0.967
Cold ischemia time (h)	1.010 (1.006-1.013)	0.000	1.008 (1.003-1.013)	0.001
Warm ischemia time (min)	1.002 (1.001-1.003)	0.000	1.002 (1.001-1.003)	0.000
Year of transplantation	0.996 (0.992-0.999)	0.017	0.987 (0.980-0.993)	0.000
Dialysis	1.507 (1.422-1.598)	0.000	1.492 (1.367-1.629)	0.000
Diabetes	1.406 (1.355-1.460)	0.000	1.314 (1.248-1.383)	0.000
COPD	1.384 (1.218-1.573)	0.000	1.250 (1.075-1.454)	0.004
Hypertension	1.207 (1.150-1.267)	0.000	1.057 (0.998-1.120)	0.059
Primary indication		0.000		0.000
HCV	1.356 (1.313-1.400)	0.000	1.429 (1.335-1.530)	0.000
Alcohol + HCV	1.214 (1.152-1.281)	0.000	1.477 (1.351-1.616)	0.000
HCV + other viral hepatitis	1.093 (0.932-1.283)	0.274	1.342 (1.098-1.638)	0.004
Other	1.020 (0.951-1.094)	0.583	1.111 (0.993-1.244)	0.067
Alcohol	1.060 (1.018-1.103)	0.005	1.188 (1.102-1.282)	0.000
HBV	0.669 (0.613-0.729)	0.000	0.782 (0.691-0.883)	0.000
PSC	0.597 (0.554-0.644)	0.000	0.709 (0.634-0.792)	0.000
PBC	0.670 (0.623-0.721)	0.000	0.715 (0.641-0.797)	0.000
NASH	0.906 (0.821-1.001)	0.051	0.953 (0.783-1.160)	0.630
Autoimmune	0.807 (0.742-0.878)	0.000	0.916 (0.810-1.036)	0.164
Acute liver failure	0.801 (0.689-0.931)	0.004	1.049 (0.822-1.339)	0.701
Congenital or metabolic disease	0.758 (0.703-0.817)	0.000	0.825 (0.736-0.926)	0.001

At multivariate analysis, after adjusting for patients’ and donors’ characteristics, primary indication for liver transplantation, comorbidities, year of transplantation and warm and cold ischemia times, class III obesity and underweight status remained independent factors associated with lower survival. HCV: Hepatitis C virus; HBV: Hepatitis B virus; PSC: Primary sclerosing cholangitis; NASH: Non-alcoholic steatohepatitis; BMI: Body mass index; COPD: Chronic obstructive pulmonary disease; PBC: Primary biliary cirrhosis.