Peri-operative Challenges in Patients Transplanted with Livers from Extreme Obese Donors
June 7, 2021
Citation: Liver Transpl. 2021 Jun 7 [Epub ahead of print]

BACKGROUND The combination of rising rates of obesity and the shortage of deceased donor livers have forced the consideration of marginal liver donors in terms of body mass index (BMI) for liver transplant (LT). To date, there is still conflicting data on the impact of donor obesity on post-LT outcomes.
METHODS We analyzed all patients undergoing LT alone in the US from October 2005 through December 2019 using the United Network of Organ Sharing (UNOS) dataset. We categorized donor BMI>40 kg/m2 as extremely obese (EO). Primary endpoints included 30-day peri-operative mortality and early graft loss (EGL) within 7 days. A subgroup analysis was performed for the EO donor group to assess how Macrovesicular steatosis (MaS)>30% affect 30 day mortality and EGL within 7 days.
RESULTS 72,616 patients underwent LT during the study period. Thirty-day perioperative mortality were significantly higher in the EO donor group (p=0.02). On multivariate analysis, recipients undergoing LT with EO donors had a 38% higher 30-day mortality risk (OR 1.38, 95% CI 1.21-1.69) and 53% increased risk of EGL (OR 1.53, 95% CI 1.22-1.90). MaS>30% was independently associated with a 2-fold increased risk of 30-day mortality (p= 0.003) and 3.5-fold increased risk of EGL within 7 days (p<0.001). The impact of MaS>30% in EGL was 2-fold for all patients transplanted during the study period compared to 3.5-fold in the EO donor group.
CONCLUSIONS There is an increased risk of EGL and 30-day perioperative mortality in recipients transplanted with EO donors. Future studies are warranted in morbid and super obese donors to assess the possible effect of obese related pro-inflammatory factors in EGL.