Establishing best practices for obesity and metabolic syndrome in liver transplantation: Insights from a modified Delphi-based controversies conference

Metabolic syndrome and obesity are prevalent and impact liver transplantation (LT) outcomes. Furthermore, the understanding of the complex physiology of obesity and availability of effective antiobesity interventions has developed rapidly. To bridge the current gap in practice guidance, the American...

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Published in:American journal of transplantation
Main Authors: Davis, Jessica P.E., Henry, Zachary, Sharma, Pratima, Tsunoda, Shirley M., Han, Hyosun, Orandi, Babak J., Heimbach, Julie K., Schulman, Allison R., Tincopa, Monica A., Argo, Curtis K., Bittermann, Therese, Chacko, Kristina R., Corey, Kathleen E., Goldaracena, Nico, Henry, Zachary H., Lee, Kelly C., Liapakis, AnnMarie, Lizaola-Mayo, Blanca C., Nadig, Satish N., Orandi, Babak, Papademetriou, Marianna, Posselt, Andrew M., Rabiee, Anahita, Reticker, Anesia, Selzner, Nazia, Sharpton, Suzanne, Siddiqui, M. Shadab, Stanford, Fatima Cody, Tincopa, Monica, Waits, Seth A., Watt, Kymberly D., Wattacheril, Julia J.
Format: Journal Article
Language:English
Published: United States Elsevier Inc 22.10.2025
Subjects:
bariatric surgery
cirrhosis
liver transplantation
metabolic syndrome
obesity
T2DM
AST
bariatric surgery
IGB
MR
LT
TBW
MASH
MASLD
EGP
metabolic syndrome
RNYGB
SG
LICOP
CSPH
ESG
CKD
liver transplantation
obesity
cirrhosis
AOM
BMI
ISSN:1600-6135, 1600-6143, 1600-6143
Online Access:Get full text
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Summary:Metabolic syndrome and obesity are prevalent and impact liver transplantation (LT) outcomes. Furthermore, the understanding of the complex physiology of obesity and availability of effective antiobesity interventions has developed rapidly. To bridge the current gap in practice guidance, the American Society for Transplantation Liver and Intestinal Community of Practice convened a controversies conference to develop expert recommendations for obesity management in the LT population. This conference used a modified Delphi method to generate consensus-based statements. Revisions at the virtual conference led to 26 best practice statements with high mean agreement and importance ratings (98% and 97%, respectively). The consensus emphasized the foundational role of nutrition and physical activity. Integration of emerging therapies such as incretin mimetics and identifying candidates for bariatric interventions are pivotal. Further research is essential to solidify these recommendations and adapt LT practices to the growing prevalence of obesity among patients and donors.
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ISSN:1600-6135
1600-6143
1600-6143
DOI:10.1016/j.ajt.2025.10.008