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

Previous guidelines considered body mass index (BMI) over 40 kg/m² a relative contra-indication to liver transplantation (LT). The aims were to examine the selection process and study outcomes of patients with Class I-III obesity.

Retrospective analysis of outcomes of obese patients assessed for LT at our center between 2010 and 2023, divided into three groups: Class I (BMI30-34.9 kg/m²), Class II (BMI35-39.9 kg/m²), and Class III (BMI>40 kg/m²). Survival of non-obese adult patients was used for comparison.

Three hundred fifteen patients with BMI ≥30 kg/m² were assessed for LT. Seventeen (5.4%) were not wait-listed due to comorbidities. One hundred sixty-eight patients were transplanted: 100 Class I, 43 Class II, and 25 Class III. There were no differences in postoperative complications (Clavien-Dindo Grade 3 or more; 41%, 42%, 48% for Class I-III obesity respectively) or patient and graft survival (5-y rates 84.4% and 82.7%, respectively, for the whole cohort) according to the different classes of obesity. Furthermore, patient and graft survival was not different between non-obese and obese patients (p = 0.932).

With a rigorous selection process, short-term outcomes after LT for patients with Class III obesity were comparable to patients with Class I-II obesity. Long-term survival was identical for obese and non-obese patients.