Liver Transplantation With Grafts From Super Obese Donors

Vargas, Paola A.; Cullen, J. Michael; Argo, Curtis K.; Henry, Zachary; Stotts, Matthew J.; Intagliata, Nicolas M.; Oberholzer, José; Pelletier, Shawn J.; Goldaracena, Nicolás

doi:10.1097/txd.0000000000001225

Transplantation Direct

2021

DOI: 10.1097/txd.0000000000001225

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Liver Transplantation With Grafts From Super Obese Donors

Paola A. Vargas

J. Michael Cullen

Curtis K. Argo

et al.

Abstract: Supplemental Digital Content is available in the text.

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“…It remains to be established if these findings can be confirmed in other countries (where the prevalence of severe obesity is different), or if the utilization of grafts from strictly selected morbidly obese donors may reduce this imbalance. 10 Although this study has merit, some important questions remain unsolved. First, obesity was assessed only at time of waitlisting using the BMI: this can change over time, at least for the group of patients who follow a medically supervised weight loss program, or undergo bariatric surgery, and for those who remain on the waiting list for a long time.…”

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confidence: 98%

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“…Translating this message into clinical practice, physicians should advise severely obese (especially male) candidates that they may remain for a longer time on the waiting list, with a higher risk of death/drop‐out. It remains to be established if these findings can be confirmed in other countries (where the prevalence of severe obesity is different), or if the utilization of grafts from strictly selected morbidly obese donors may reduce this imbalance 10 …”

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Transplanting severely obese cirrhotic patients: Heavy clouds still on the horizon

Burra

Ferrarese²

2022

UEG Journal

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Transplanting severely obese cirrhotic patients: Heavy clouds still on the horizonObesity represents one of the major epidemiologic challenges of this century, causing more than 300,000 premature deaths per year, increased healthcare costs and social stigma. 1 More than 75% of obese and >90% severely obese people develop non-alcoholic fatty liver disease, 2 which in turn becomes a strong risk factor for liver fibrosis, cirrhosis and hepatocellular carcinoma. This obesity epidemic is therefore also showing its strong effects in the liver transplant (LT) setting, with an increasing proportion of obese or morbidly obese potential LT candidates.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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confidence: 98%

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confidence: 99%

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confidence: 99%

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Transplanting severely obese cirrhotic patients: Heavy clouds still on the horizon

Burra

Ferrarese²

2022

UEG Journal

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Impact of Donor Obesity on Graft and Recipient Survival Outcomes After Liver Transplantation: A Systematic Review and Meta-analysis

Alnagar,

Hajibandeh,

Hajibandeh

et al. 2024

Transplantation Direct

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Background. The effect of donor body mass index (BMI) on liver transplantation (LT) outcomes remains unclear. Methods. A systematic search of the MEDLINE, CENTRAL, Web of Science, and bibliographic reference lists was conducted. All comparative studies evaluating the outcomes of LT in obese (BMI > 30 kg/m2) and nonobese donors (BMI < 30 kg/m2) were included, and their risk of bias was assessed using the ROBINS-I assessment tool. Patient and graft survival, acute rejection, and graft failure requiring retransplantation were evaluated as outcome parameters. A random-effects model was used for outcome synthesis. Results. We included 6 comparative studies reporting a total of 5071 liver transplant recipients from 708 obese and 4363 nonobese donors. There was no significant difference in 1-y (89.1% versus 84.0%, odds ratio [OR] 1.58; 95% CI 0.63-3.94, P = 0.33), 5-y (74.2%% versus 73.5%, OR 1.12; 95% CI 0.45-2.80, P = 0.81) graft survival, and 1-y (87.1% versus 90.3%, OR 0.71; 95% CI 0.43-1.15, P = 0.17) and 5-y (64.5% versus 71.6%, OR 0.71; 95% CI 0.49-1.05, P = 0.08) patient survival between 2 groups. Furthermore, recipients from obese and nonobese donors had a comparable risk of graft failure requiring retransplantation (OR 0.92; 95% CI 0.33-2.60, P = 0.88) or acute graft rejection (OR 0.70; 95% CI 0.45-1.11, P = 0.13). Conclusions. A meta-analysis of the best available evidence (level 2a) demonstrates that donor obesity does not seem to have a negative impact on graft or patient outcomes. The available studies might be subject to selection bias as the grafts from obese donors are usually subject to biopsy to exclude steatosis and the recipients usually belong to the low-risk group. Future research is needed to evaluate the impact of donors subgrouped by various higher BMI on graft and patient-related outcomes as well as to capture data of the discarded grafts from obese donors; hence, selection criteria for the grafts that could be used for transplantation from obese donors is identified.

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Liver Transplantation With Grafts From Super Obese Donors

Abstract: Supplemental Digital Content is available in the text.

Cited by 2 publications

References 17 publications

Transplanting severely obese cirrhotic patients: Heavy clouds still on the horizon

Transplanting severely obese cirrhotic patients: Heavy clouds still on the horizon

Impact of Donor Obesity on Graft and Recipient Survival Outcomes After Liver Transplantation: A Systematic Review and Meta-analysis

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