The negative effect of pretransplant overweight and obesity on the rate of improvement in physical quality of life after liver transplantation Victor Zaydfudim, MD, MPH, a Irene D. Feurer, PhD, a,b Derek E. Moore, MD, MPH, a Panarut Wisawatapnimit, MSN, PhD, c J. Kelly Wright, MD, a and C. Wright Pinson, MBA, MD, a Nashville, TN Background. Recent studies suggest that obesity does not affect survival after liver transplantation. Overweight and obesity, however, impair health-related quality of life (HRQOL) in patients with chronic illnesses. We tested the effect of pretransplant body weight on HRQOL in liver transplant recipients. Methods. Prospective, longitudinal HRQOL data were collected using the SF-36 health survey. Pretransplant body weight was stratified based on body mass index (BMI), as follows: normal (18.5-- 24.9), overweight (25.0--29.9), and obese ($30.0). Linear mixed-effects models were used to test the effects pretransplant BMI category on the trajectory of HRQOL after liver transplantation. Results. The sample included 154 adults who underwent liver transplantation. Thirty-one percent had normal BMI, 41% were overweight, and 28% were obese pretransplant. The mean pretransplant physical HRQOL did not differ by BMI group (P $ .697). Physical and mental HRQOL improved (P < .001) in all groups after transplantation, but the rate of improvement in physical HRQOL was significantly greater during the first year posttransplant in the normal BMI compared with the over- weight and obese patients (P # .032). There was no effect of BMI on the rate of improvement in mental HRQOL. Conclusion. Excess pretransplant body weight hinders the rate of improvement in physical quality of life during the first year after liver transplantation. (Surgery 2009;146:174-80.) From the Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, a the Department of Biostatistics, b and the School of Nursing, c Vanderbilt University Medical Center, Nashville, TN THE OBESITY EPIDEMIC IN THE GENERAL POPULATION has been paralleled by a significant increase in the num- ber of overweight and obese patients awaiting solid organ transplantation. 1 Recent estimates indicate that, currently, approximately 30% of patients under- going liver transplantation are obese, with a body mass index (BMI) $30.0 kg/m 2 . 2 Although several large population-based studies suggest that obesity does not impact survival after liver transplantation, 2,3 the effects of pretransplant obesity on posttransplant health-related quality of life (HRQOL) in this patient population have not been well established. Obesity has been shown to affect HRQOL in patients with chronic illness by reducing physical function components in patients who are over- weight and obese. 4 An investigation of overweight patients with chronic liver disease suggested that even a modest weight loss and ongoing physical activity improved both physical and mental compo- nents of HRQOL. 5 Studies that evaluated HRQOL in liver transplant recipients demonstrated improve- ments from pretransplant measurements to post- transplant assessments. 6,7 The aim of this research was to investigate the effect of pretransplant overweight and obesity on HRQOL after liver trans- plantation. We hypothesized a more pronounced improvement in HRQOL in normal-weight liver Supported by the Institutional National Research Service Award T32 HS 013833 from the Agency of Healthcare Research and Quality, U.S. Department of Health and Human Services, and by a general educational award from the Novartis Pharmaceuti- cals Corporation. Presented at the 4th Annual Academic Surgical Congress, Fort Myers, Florida, February 3--5, 2009. Accepted for publication April 6, 2009. Reprint requests: Victor Zaydfudim, MD, MPH, Department of Surgery, Vanderbilt University Medical Center, D-4314 Medical Center North, Nashville, TN 37232-2730. E-mail: vic.zaydfudim@ vanderbilt.edu. 0039-6060/$ - see front matter Ó 2009 Mosby, Inc. All rights reserved. doi:10.1016/j.surg.2009.04.027 174 SURGERY