Outcomes of living donor liver transplant in elevated body mass index over a decade in the United States

Abstract

Introduction

Living donor liver transplant (LDLT) is a treatment option for end stage liver disease (ESLD). This study assesses the impact of recipient BMI on LDLT outcomes.

Methods

The United Network for Organ Sharing (UNOS) database was reviewed for adult LDLTs between January 2010 and December 2020. Recipients were stratified by BMI: Normal: < 25 kg/m²; Overweight: 25 to <30 kg/m², Class 1 Obesity: 30 to <35 kg/m², and Class 2/3 Obesity: ≥35 kg/m². Recipient and donor characteristics, and post-transplant graft failure and mortality were compared.

Results

3068 patients were included. The mean age was 53 ± 13 years. The prevalence of diabetes and MASH cirrhosis was positively correlated with higher BMI groups (p < 0.0001 and p < 0.0001). At 5-years, graft failure (GF) in each group was 7.7 %, 5.2 %, 4.2 %, and 3.5 %, respectively (p = 0.0091). At 5 years, rate of death in each group was 11.2 %, 12.5 %, 10.7 %, and 10.4 %, respectively (p = 0.61). After controlling for patient demographics, clinical characteristics, and donor age, weight was no longer associated with graft failure or death.

Conclusion

In this retrospective analysis, recipient BMI did not correlate with death, and obesity is associated with lower rates of graft failure. Obesity alone should not preclude candidacy for LDLT.