Donor Body Mass Index and Utilization of Liver Biopsy: An Evaluation of National Practices and Organ Utilization.
1Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
2Surgery, Oregon Health and Science University, Portland, OR
Meeting: 2017 American Transplant Congress
Abstract number: C197
Keywords: Biopsy, Donation, Liver grafts, Weight
Session Information
Session Name: Poster Session C: Organ Allocation, Meld Score, Organ Utilization, and Transplant Outcomes
Session Type: Poster Session
Date: Monday, May 1, 2017
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall D1
Background: As the prevalence of obesity in America increases, so has the proportion of donors with elevated body mass index (BMI). While graft steatosis >30% has been associated with worse outcomes, the utilization of liver biopsy in donor evaluation is poorly reported. Here we examine nationally collected data to evaluate the influence of donor BMI and biopsy use upon organ utilization rates.
Methods: Prospective nationally collected data from UNOS on donation after neurologic determination of death from June 1, 2006 to June 30, 2016 was obtained, and 72,084 adults were identified. Donors were categorized by BMI into 5 groups, 1=18.5-24.9 kg/m2 (n=24,270, 33.7%), 2=25-29.9 kg/m2 (24314, 33.7%), 3=30-34.9 kg/m2 (13288, 18.4%), 4=35-39.9 kg/m2 (5980, 8.3%), and 5= ≥40 kg/m2 (4232, 5.9%). Biopsies were performed in 28,021 (38.9%) cases, and were categorized by presence of macroscopic steatosis <30% or ≥30%. Univariate and multivariate analyses were performed.
Results: Demographic data was evaluated, including mean age (44.1±15.3 years) and BMI (28.5±6.6 kg/m2) of all donors. Liver biopsy (Bx+) rates varied across all 11 OPOs (p<0.001). Bx+ was more likely as BMI increased (Group 1=30.3%, 2=35.4%, 3=45.0%, 4=55.8%, 5=65.3%, p<0.001). Biopsy finding of macrosteatosis >30% also increased with BMI (Group 1= 9.7%, 2= 14.5%, 3= 19.5%, 4= 20.4%, 5= 24.6%, p<0.001). Liver utilization rates decreased in a similar fashion (Group 1= 79.6%, 2= 76.2%, 3=69.9%, 4= 64.7%, 5=55.3%, p<0.001). Bx+ were more common in older patients, males, donors with histories of diabetes mellitus (DM) and hypertension (HTN), p<0.001 for all. Multivariate regression identified macrosteatosis >30% (OR=0.95, 95% CI 0.947-0.951), BMI (0.984, 0.98-0.99), age (0.98, 0.986-0.991) and serum bilirubin (0.84, 0.81-0.87) as significant predictors against liver utilization. Macrosteatosis >30% was seen in 24.6% of donors with BMI >40 and accounted for 8.4% of transplanted livers with biopsy data.
Conclusions: Expansion of the donor pool is necessary to accommodate growing waitlists. Our data confirm that BMI is an important predictor of liver utilization, yet more liberal use of biopsy may help identify additional organs suitable for transplant.
CITATION INFORMATION: Steggerda J, Marguiles D, Malinoski D, Bloom M. Donor Body Mass Index and Utilization of Liver Biopsy: An Evaluation of National Practices and Organ Utilization. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Steggerda J, Marguiles D, Malinoski D, Bloom M. Donor Body Mass Index and Utilization of Liver Biopsy: An Evaluation of National Practices and Organ Utilization. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/donor-body-mass-index-and-utilization-of-liver-biopsy-an-evaluation-of-national-practices-and-organ-utilization/. Accessed May 13, 2025.« Back to 2017 American Transplant Congress