gms | German Medical Science

Background: Organ shortage is a major problem in liver transplantation. The use of extended criteria donors has become the most important strategy for increasing the donor pool. However, the role of donor body mass index has not yet been thoroughly investigated. The aim of our study was to compare outcomes after liver transplantation in patients who received a donor liver from a donor with a BMI <30, 30-39 and ≥40, with special regard to the incidence of early allograft dysfunction (EAD) and primary non-function (PNF).

Materials and methods: One hundred and sixty-three consecutive patients who received liver transplantation at the University Hospital Aachen between June 2010 and January 2014 were included in this retrospective analysis. Patients with combined kidney-liver transplantation, living-donor liver transplantation and split liver transplantation were excluded. The patient cohort was divided into three groups according to donor body mass index (BMI) (BMI<30, BMI 30-39, and BMI ≥40). The outcome of liver transplantation was evaluated by the 30-day and 1-year patient and graft survival rates and the incidences of postreperfusion syndrome (PRS), EAD and PNF.

Results: The BMI 30-39 group had a significantly higher incidence of EAD than the BMI <30 and BMI ≥40 groups (64.5% vs. 33.3% and 26.7%, respectively) (p= 0.005). The median ALT concentrations immediately postoperatively and on POD 1 were statistically significantly higher in the BMI 30-39 and BMI ≥40 groups than in the BMI <30 group (845 U/l and 763 U/l vs. 454 U/l and 599 U/l and 617 U/l vs. 480 U/l, respectively, p=0.018 and p=0.002). We observed 5 cases (3.6%) of PNF, all of which occurred in the BMI <30 group (p=0.718). The incidence of acute renal failure was significantly higher in the BMI 30-39 and BMI ≥40 groups than in the BMI<30 group (26% and 13% vs. 5%, respectively, p<0.001). All patients recovered without the need for permanent dialysis. Creatinine values at 6 months after LT were not significantly different between the three groups (p=0.292). The number of rejections was not different between the groups (p=0.944). The 30-day patient survival rates were 96.4% in the BMI <30 group, 96.8% in the BMI 30-39 group and 100% in the BMI ≥40 group (p=0.758). The one-year patient survival rates were 90.1% in the BMI <30 group, 87.1% in the BMI 30-39 group and 100% in the BMI ≥40 group (p=0.40).

Conclusion: In summary, based on our findings, grafts from obese donors with a BMI >30 can safely be transplanted. Therefore the donor pool can be enlarged to include such obese donors without negatively impacting patient outcome after liver transplantation. Significant differences between the donor BMI groups occurred only during the first three postoperative days. Due to optimal patient management intraoperatively and at the ICU, these differences can be compensated without causing permanent handicaps for the patients.