Liver Transplantation in Well-Selected Class III Obese Recipients Yields Good Outcomes

Area of Science:

• Hepatology
• Transplantation Surgery
• Obesity Medicine

Background:

• Previous guidelines contra-indicated liver transplantation (LT) for body mass index (BMI) over 40 kg/m².
• Obesity is a growing concern in patients requiring LT.
• Understanding outcomes in obese populations is crucial for refining LT criteria.

Purpose of the Study:

• To evaluate the selection process and outcomes of obese patients undergoing LT.
• To compare outcomes across different classes of obesity (Class I, II, and III).
• To assess long-term survival in obese versus non-obese LT recipients.

Main Methods:

• Retrospective analysis of 315 obese patients assessed for LT (2010-2023).
• Patients categorized into Class I (BMI 30-34.9), Class II (BMI 35-39.9), and Class III (BMI >40 kg/m²).
• Comparison of outcomes with non-obese adult patients.

Main Results:

• 168 patients were transplanted; 25 had Class III obesity.
• No significant differences in postoperative complications (Clavien-Dindo Grade ≥3) across obesity classes.
• Identical 5-year patient and graft survival rates observed between obese and non-obese groups (p=0.932).

Conclusions:

• Rigorous selection enables comparable short-term LT outcomes for Class III obese patients.
• Long-term survival after LT is identical for obese and non-obese patients.
• Current guidelines may be overly restrictive regarding obesity in LT candidates.