Liver Transplantation with Super Obese Donors (BMI≥50) Grafts: An Acceptable Pathway to Expand the Donor Pool. Analysis of the OPTN/UNOS Liver Transplant Registry

P. Vargas¹, C. Argo², H. Zachary², M. Stotts², N. Intagliata², P. Northup², J. Oberholzer¹, S. Pelletier¹, N. Goldaracena¹

¹Transplant Surgery, University of Virginia Health System, Charlottesville, VA, ²Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, VA

Meeting: 2021 American Transplant Congress

Abstract number: 1161

Keywords: Donors, marginal, Liver grafts, Liver transplantation, Obesity

Topic: Clinical Science » Liver » Liver: MELD, Allocation and Donor Issues (DCD/ECD)

Session Information

Session Name: Liver: MELD, Allocation and Donor Issues (DCD/ECD)

Session Type: Poster Abstract

Session Date & Time: None. Available on demand.

Location: Virtual

*Purpose: We aimed to analyze the impact of donor body mass index (BMI) on recipient morbidity and survival following liver transplantation (LT).

*Methods: The UNOS-STAR database was queried to identify adult patients undergoing LT from 2010-2019. Records of recipients and donors <18 years, donors with BMI <18, transplants before 2010, split-LT, living donors LT, DCD and multi-organ transplants were excluded from the analysis. Graft outcomes were analyzed by univariate analyses. Graft and patient survival were assessed by Kaplan-Meier curves.

*Results: 45,721 patients were identified. Of these, 45,300 patients received a graft from a donor with BMI<50 (BMI<50 group) and 421 from a super obese donor (BMI≥50 group). Recipients median (IQR) age (57 (51-63) vs 58 (52-64), p=0.11) and BMI (28.1 (24.6-32.4) vs 29 (25.5-33.3), p=0.43) were similar in the donor BMI<50 group vs donor BMI≥50 group, respectively. Proportion of males among groups were significantly higher in the donor BMI≥50 group (79.1% vs 67.4%, p=<0.001). Donor mean age was significantly higher in the donor BMI≥50 group (47 (38-55) vs 44 (30-56), p=<0.001). By definition donor BMI was significantly higher in the donor BMI≥50 group (54.1 (51.7-57.6) vs 27.1 (23.8-31.4), p=<0.001). Proportion of donor males were significantly higher in the BMI<50 group (59.0% vs 24.9%, p=0.001). The percentage of liver biopsy performed was significantly higher in the BMI≥50 group (83.4% vs 41.5%, p=<0.001). Among those with liver biopsy, the median (IQR) of reported percentage of macrosteatosis was 10% (4-20) in the donor BMI≥50 group vs 5% (0-10) in the donor BMI <50 group, p=<0.001). Macrosteatosis ≥30% was present in 56/339 (16%) in the donor BMI≥50 group vs 1626/17940 (8.6%) in the donor BMI<50 group, p=<0.001. Mean CIT was similar between groups. Median length of stay after LT was significantly longer in the donor BMI<50 group (10 (0-737) vs 9 (0-126) days, p=<0.001). Graft failure, recipient death and re-transplant rates were similar between groups (5.7%, 16.9% and 2.5% for the donor BMI<50 group and 5.7%, 14.7% and 2.6% in the donor BMI≥50 group, respectively, p=0.61). Graft and patient survival at 1-, 3- and 5- year were similar between groups (89%, 79%, 73% vs 88%, 81%, 71%, p=0.83, and 91%, 81%, 75% vs 91%, 83%, 71%, p=0.87, in the donor BMI <50 group vs donor BMI≥50 group, respectively).

*Conclusions: The use of grafts from super obese donors can safely expand the organ pool in selected recipients. Grafts from super obese donors should not be rule out based solely on their BMI and biopsy of these grafts might play an important role in the decision-making process.

To cite this abstract in AMA style:

Vargas P, Argo C, Zachary H, Stotts M, Intagliata N, Northup P, Oberholzer J, Pelletier S, Goldaracena N. Liver Transplantation with Super Obese Donors (BMI≥50) Grafts: An Acceptable Pathway to Expand the Donor Pool. Analysis of the OPTN/UNOS Liver Transplant Registry [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/liver-transplantation-with-super-obese-donors-bmi%e2%89%a550-grafts-an-acceptable-pathway-to-expand-the-donor-pool-analysis-of-the-optn-unos-liver-transplant-registry/. Accessed May 9, 2025.

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