Efficacy and safety of pharmacological therapy of obesity in liver transplant candidates

Prior treatment

• Combined liver-kidney transplantation.
• Sarcopenia according to pre-transplant CT.

Other illness

• Pregnancy (pre-enrollment assessment includes a pregnancy test; women of childbearing potential must agree to use highly effective contraception — hormonal or barrier methods, or abstinence; highly effective methods are defined as those with failure rate <1% per year with correct and consistent use).
• History of acute or chronic pancreatitis.
• Polycystic liver disease
• Type 1 diabetes mellitus
• Liver malignancy outside Milan criteria (Milan-out, Klatskin tumor, colorectal carcinoma metastases, NET metastases).
• Unstable clinical condition or unplanned hospitalization due to significant deterioration or complication.

Other

• Hepatic encephalopathy
• Refractory ascites/hydrothorax (≥2 evacuation procedures in the last 2 months).
• Spontaneous weight loss (≥5% in the past 6 months, not due to diuretic or evacuation treatment).
• Inability to perform physical activity (walking 30 min/day).

• Liver transplant candidate undergoing pre-transplant evaluation (inpatient or outpatient) at the Department of Hepatogastroenterology, aged ≥18 years.
• BMI ≥ 30, or BMI ≥ 33 in case of significant fluid retention (edema of lower extremities, ascites, hydrothorax; for large ascites/hydrothorax, BMI will be evaluated after evacuation puncture).
• Clinically stable (patient is at home under outpatient follow-up or hospitalized on a standard ward without clinical or laboratory signs of significant deterioration or complications).
• Signed informed consent.