Outcomes of Liver Transplantation in Patients With Severe Obesity

Authors

• Alejandro Cracco, University of Kentucky College of MedicineFollow
• Mackenzie Donoho, University of Kentucky College of MedicineFollow
• Siddharth Desai, University of Kentucky College of MedicineFollow
• Meera Gupta, University of KentuckyFollow
• Alexandre Ancheta, University of Kentucky College of MedicineFollow
• Malay B. Shah, University of KentuckyFollow
• Xiaonan Mei, University of Kentucky College of MedicineFollow
• Francesc Marti, University of KentuckyFollow
• Roberto Gedaly, University of KentuckyFollow

Abstract

Background. – This study aims to evaluate the impact of obesity on post–liver transplant outcomes stratified by low- and high-performance status. Methods. – Patients undergoing liver transplantation between 2006 and 2023 were identified in the United Network for Organ Sharing data set. Patients with severe obesity body mass index ([BMI] ≥40 kg/m²) and super obesity (BMI >50 kg/m²) were compared with those with lower BMI on perioperative and long-term outcomes stratified by preoperative performance status. Results. – Severe obesity has a significant negative impact on perioperative and long-term outcomes on the low-performance group (LPG). This effect was not observed in the high-performance group. Five-year survival in the high-performance group was 81.7%, compared with 77.9% in the LPG. The multivariable analysis revealed that severe obesity in the LPG increased early graft loss by 53%, and 30- and 90-d mortality by 57% and 50%, respectively (P < 0.001). Severe obesity significantly impacted overall graft survival but did not affect long-term patient survival. When advanced age was combined with severe obesity in the LPG, our analysis showed a 2.3-fold increased risk of early graft loss (P = 0.01) and 83%, 90-d perioperative mortality (P < 0.001). Overall long-term graft and patient survival were decreased by 56% and 59%, respectively, in the LPG (P < 0.001). Conclusions. – Severe obesity in patients with a low-performance status before transplantation significantly increases the risk of poor perioperative and long-term outcomes. Interestingly, this effect is not seen in patients with high-performance scores. Additionally, the combination of severe obesity and advanced age in low-performance status patients may have a compounded negative effect on posttransplant survival.

Document Type

Article

Publication Date

9-19-2025

Notes/Citation Information

Publisher Copyright: Copyright © 2025 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc.

Digital Object Identifier (DOI)

10.1097/TXD.0000000000001863

Archival?

Archival

Repository Citation

Cracco, Alejandro; Donoho, Mackenzie; Desai, Siddharth; Gupta, Meera; Ancheta, Alexandre; Shah, Malay B.; Mei, Xiaonan; Marti, Francesc; and Gedaly, Roberto, "Outcomes of Liver Transplantation in Patients With Severe Obesity" (2025). Surgery Faculty Publications. 75.
https://uknowledge.uky.edu/surgery_facpub/75