{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T21:14:44Z","timestamp":1793394884145,"version":"4.5.0"},"reference-count":44,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2022,8,5]],"date-time":"2022-08-05T00:00:00Z","timestamp":1659657600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2023,1,17]],"date-time":"2023-01-17T00:00:00Z","timestamp":1673913600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:p>Lean individuals with nonalcoholic fatty liver disease (NAFLD) represent a subset of patients with a distinct risk factor profile. We assessed the association between body mass index (BMI) on waitlist and postliver transplantation (LT) outcomes among these patients. We retrospectively analyzed the United Network for Organ Sharing data, including adult patients with NAFLD listed for LT between February 27, 2002, and June 30, 2020. We first used competing risk analyses to estimate the association of BMI with waitlist removal due to death or clinical deterioration. We then conducted Kaplan\u2013Meier estimates and Cox regression models to determine the impact of weight change during the waiting list on all\u2010cause mortality and graft failure after LT. Patients with normal weight (BMI 18.5\u201324.9\u2009kg\/m<jats:sup>2<\/jats:sup>) suffered higher waitlist removal (adjusted subdistribution hazard ratio 1.26, 95% confidence interval [CI] 1.10\u20131.43; <jats:italic toggle=\"yes\">p<\/jats:italic> = 0.001) compared with patients with obesity class I (BMI 30\u201334.9\u2009kg\/m<jats:sup>2<\/jats:sup>). Those who remained at normal weight had higher all\u2010cause mortality (adjusted hazard ratio [aHR] 1.61, 95% CI 1.32\u20131.96; <jats:italic toggle=\"yes\">p<\/jats:italic>\u2009&lt;0.001) and graft failure (aHR 1.57, 95% CI 1.32\u20131.88; <jats:italic toggle=\"yes\">p<\/jats:italic>\u2009&lt;0.001) than patients with stable obesity. Among patients with normal weight, those with the greatest weight increase (BMI gain \u22653\u2009kg\/m<jats:sup>2<\/jats:sup>) had lower all\u2010cause mortality (aHR 0.55, 95% CI 0.33\u20130.93; <jats:italic toggle=\"yes\">p<\/jats:italic> = 0.03) and graft failure (aHR 0.49, 95% CI 0.30\u20130.81; <jats:italic toggle=\"yes\">p<\/jats:italic> = 0.01) compared with patients with stable weight (BMI change \u22641\u2009kg\/m<jats:sup>2<\/jats:sup>). Patients with NAFLD with normal weight have increased waitlist removal and those who remained at normal weight during the waitlist period have worse posttransplantation outcomes. Identifying and addressing factors influencing apparent healthy weight prior to LT are crucial to mitigate poor outcomes.<\/jats:p>","DOI":"10.1002\/lt.26531","type":"journal-article","created":{"date-parts":[[2022,6,18]],"date-time":"2022-06-18T02:48:53Z","timestamp":1655520533000},"page":"145-156","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":10,"title":["Waitlist and posttransplantation outcomes of lean individuals with nonalcoholic fatty liver disease"],"prefix":"10.1097","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7826-655X","authenticated-orcid":false,"given":"Pedro","family":"Ochoa\u2010Allemant","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8328-9211","authenticated-orcid":false,"given":"Hirsh D.","family":"Trivedi","sequence":"additional","affiliation":[{"name":"Liver Center, Division of Gastroenterology, Hepatology, and Nutrition, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Behnam","family":"Saberi","sequence":"additional","affiliation":[{"name":"Liver Center, Division of Gastroenterology, Hepatology, and Nutrition, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan","family":"Bonder","sequence":"additional","affiliation":[{"name":"Liver Center, Division of Gastroenterology, Hepatology, and Nutrition, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary P.","family":"Fricker","sequence":"additional","affiliation":[{"name":"Liver Center, Division of Gastroenterology, Hepatology, and Nutrition, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,1,17]]},"reference":[{"key":"lt26531-bib-0001-20250824","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1002\/hep.28431","article-title":"Global epidemiology of nonalcoholic fatty liver disease\u2010meta\u2010analytic assessment of prevalence, incidence, and outcomes","volume":"64","year":"2016","journal-title":"Hepatology"},{"key":"lt26531-bib-0002-20250824","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1002\/hep.29367","article-title":"The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver 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