Understanding the Impact of Obesity on Liver Transplant Outcomes: A Comprehensive Analysis

The purpose of this investigation is to assess how effective it is to exclude individuals from the liver transplant (LT) using the body mass index (BMI) as a criterion.

A retrospective longitudinal analysis of patients with liver transplant outcomes from January 2001 to May 2020 was conducted using the United Network for Organ Sharing (UNOS) database.

A total of 118,486 LT cases included in the study. Based on their BMI, patients were split into three groups: a BMI < 35 kg/m², a 35 ≤ BMI < 40 kg/m², and a BMI ≥ 40 kg/m². The data analysis revealed a significant improvement in 10-year graft survival in the 2011-2020 group compared to the 2001-2010 group (mean 70% vs. 53% and P < 0.001). Interestingly, a BMI above 35 kg/m² did not have a significant effect on the graft survival, and in both time frames, there was no clinically significant difference between the recipients of the different BMI spectrum. The patient's survival was also characterized by the same pattern. Primary graft failure was the most significant cause of allograft transplant failure in all the BMI spectrum, except recipients with a BMI < 35 kg/m², in 2011-2020 group.

The outcomes of LT in patients requiring a LT are not significantly affected using the BMI, considering the advancements in surgical techniques and postoperation improvements, and excluding obese patients based on the BMI alone would be inappropriate.