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Severe donor obesity increased risk for graft loss, death in liver transplant patients
Patients receiving liver transplants from severely obese adult donors were more likely to die or experience graft loss than those whose donors had lower BMI in a recent study.
Researchers evaluated data on 3,788 pediatric liver transplants performed between 2004 and 2010, with data on 9,103 patients between 1990 through 2010 used to measure donor weight status over time. In the 2004 to 2010 data set, 1,259 patients had adult donors and 2,529 had pediatric donors.
Between 2004 and 2010, adult donors were overweight or obese with greater frequency than during earlier time periods: 30% of donors were overweight, 8% were obese and 2% were severely obese (P<.001). Pediatric donors were overweight in 16% of cases, obese in 6% and severely obese in 3% from 2004 to 2010. Numbers of overweight and obese pediatric donors were consistent from 1990 to 2010, but the number of underweight donors was smaller during 2004 to 2010 (P<.001).
Multivariate analysis indicated an association between severely obese adult donors and risk for graft loss (HR=2.54; 95% CI, 1.29-5.01) and death (HR=3.56; 95% CI, 1.64-7.72). Overweight pediatric donors were not significantly associated with mortality risk (HR=1.31; 95% CI, 0.98-1.77). No association was found between obese or severely obese pediatric donors and mortality risk.
Post-procedure obesity was not associated with donor weight status for either adult or pediatric donors. The strongest predictor for obesity following the procedure was the weight status of the recipient, with an OR of 4.43 (1.65-11.92) among those with adult donors and 5.73 (3.65-9.00) among those with pediatric donors for overweight or obese recipients compared with those of normal weight (95% CI for both).
“This analysis suggests that adults with a [donor body mass index (dBMI)] of 25 to <35 kg/m2 may be acceptable candidates for living donor or deceased donation,” the researchers wrote. “Severely obese adults [dBMI ≥35 kg/m2] should be considered very high-risk donors. … Because of the increasing prevalence of overweight donors, further research on the impact of donor obesity and graft steatosis on pediatric liver transplantation as well as the role of obesity in decision-making about donor acceptability is needed.”