Donor BMI and Post-living Donor Liver Transplantation Outcomes: A Preliminary Report

Jessica S Lin; Haris Muhammad; Timothy Lin; Ihab Kamel; Azarakhsh Baghdadi; Nicole Rizkalla; Shane E Ottmann; Russell Wesson; Benjamin Philosophe; Ahmet Gurakar

doi:10.1097/TXD.0000000000001431

Donor BMI and Post-living Donor Liver Transplantation Outcomes: A Preliminary Report

Transplant Direct. 2023 Jan 12;9(2):e1431. doi: 10.1097/TXD.0000000000001431. eCollection 2023 Feb.

Authors

Affiliations

¹ Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
² Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, MD.
³ Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD.
⁴ Department of Anesthesia, Johns Hopkins University School of Medicine, Baltimore, MD.
⁵ Division of Transplant Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.

Abstract

Living liver donor obesity has been considered a relative contraindication to living donation given the association with hepatic steatosis and potential for poor donor and recipient outcomes. We investigated the association between donor body mass index (BMI) and donor and recipient posttransplant outcomes.

Methods: We studied 66 living donors and their recipients who underwent living donor liver transplant at our center between 2013 and 2020. BMI was divided into 3 categories (<25, 25-29.9, and ≥30 kg/m²). Magnetic resonance imaging-derived proton density fat fraction was used to quantify steatosis. Donor outcomes included length of stay (LOS), emergency department visits within 90 d, hospital readmissions within 90 d, and complication severity. Recipient outcomes included LOS and in-hospital mortality. The Student t test was used to compare normally distributed variables, and Kruskal-Wallis tests were used for nonparametric data.

Results: There was no difference in donor or recipient characteristics based on donor BMI. There was no significant difference in mean magnetic resonance imaging fat percentage among the 3 groups. Additionally, there was no difference in donor LOS (P = 0.058), emergency department visits (P = 0.64), and hospital readmissions (P = 0.66) across BMI category. Donor complications occurred in 30 patients. There was no difference in postdonation complications across BMI category (P = 0.19); however, there was a difference in wound complications, with the highest rate being seen in the highest BMI group (0% versus 16% versus 37%; P = 0.041). Finally, there was no difference in recipient LOS (P = 0.83) and recipient in-hospital mortality (P = 0.29) across BMI category.

Conclusions: Selecting donors with BMI ≥30 kg/m² can result in successful living donor liver transplantation; however, they are at risk for perioperative wound complications. Donor counseling and perioperative strategies to mitigate wound-related issues should be used when considering obese living donors.