Evaluating the impact of donor obesity on liver transplantation outcomes: the role of donor gender and age.

Abstract

Obesity is increasing in the U.S., with more liver donors having body mass index (BMI)=35. BMI is an imperfect indicator of visceral obesity and hepatosteatosis, complicating its impact on graft survival (GS).Adult deceased donor data from the United Network for Organ Sharing database (2010-2023) were analyzed. The impact of donor obesity (BMI=35) on short- and long-term GS was examined, stratified by donor gender and age, two factors related to visceral obesity.Donors with BMI=35 doubled over the study period, comprising 18.2 % of donation after brain death donors in 2023. Grafts from male donors with BMI=35 had worse 30-day GS than grafts from donors with BMI<35 (hazard ratio 1.47, P < 0.01), but not in grafts from female donors with BMI=35 or in 5-year GS. Donor obesity increased risk only in grafts from male donors under 55 (hazard ratio 1.58, P < 0.01), with no effect in grafts from older male or female donors.Donor BMI=35 was associated with increased risk of short-term graft loss, especially among grafts from male donors. However, grafts from female donors with BMI=35 and from male donors aged=55 with BMI=35 may warrant broader use.

View details for DOI 10.1016/j.hpb.2026.01.014

View details for PubMedID 41702769