Obesity

A significant minority of patients develop rapid weight gain following liver transplantation. To some extent this is a normal response to a long period of poor oral intake, high catabolism due to their previous chronic liver disease, and the catabolism inherent to a major surgical procedure. It comes as no surprise that patients have little muscle mass at the outset of the posttransplantation period. With reversal of this pathophysiology postoperatively, the recipient being in their home setting surrounded by all the food that they like to eat, and with their appetite urged on by the effects of corticosteroid, these patients rapidly regain their normal muscle mass. Unfortunately, a significant minority of these patients continue to gain weight and become obese.

Many of the liver allograft recipients have dealt appropriately with this problem over the last four to five years with a two-pronged approach. The first approach is sensible dieting in either a controlled or uncontrolled environment. Some patients have had improvement in their weight control with conventional diets, and others have opted for specialized "liquid" diets. This liquid diet has been safe for the two patients who have opted for this type of management. The dieting must be monitored not only by a physician experienced in this weight loss field, but also by the transplantation surgeon/physician. Most important areas of monitoring include electrolytes and liver function tests.

The second and necessary prong in the approach to successful weight reduction and control is stepwise and sensible exercise (running, stationary bike, and especially swimming). A number of our older recipients are less active than their younger counterparts, and therefore they metabolize less calories on a daily basis. They appear to be most prone to this problem of obesity. Exercise has been the key intervention that has improved weight control in those patients with "dieting resistant" obesity. Altering immunosuppressive drugs or other drug manipulations such as steroids has no place in this particular problem.