Perioperative Challenges in Patients Transplanted with Livers from Extreme Obese Donors

Deepa Valvi, Diego Villagomez, Malay B. Shah, Xiaonan Mei, Meera Gupta, Alexandre Ancheta, Francesc Marti, Siddharth Desai, Karim Benrajab, Roberto Gedaly

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


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 transplantation (LT). To date, there are still conflicting data on the impact of donor obesity on post-LT outcomes. We analyzed all patients undergoing LT alone in the United States (US) from October 2005 through December 2019 using the United Network of Organ Sharing (UNOS) data set. We categorized donor BMI >40 kg/m2 as extremely obese (EO). Primary endpoints included 30-day perioperative 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% affects 30-day mortality and EGL within 7 days. A total of 72,616 patients underwent LT during the study period. The 30-day perioperative mortality was 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 (odds ratio [OR], 1.38; 95% confidence interval [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 with 3.5-fold in the EO donor group. 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 obesity-related proinflammatory factors in EGL.

Original languageEnglish
Pages (from-to)1824-1829
Number of pages6
JournalLiver Transplantation
Issue number12
StatePublished - Dec 2021

Bibliographical note

Publisher Copyright:
Copyright © 2021 by the American Association for the Study of Liver Diseases

ASJC Scopus subject areas

  • Surgery
  • Hepatology
  • Transplantation


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