Outcomes of right lobe donors with BMI≥30 for living donor liver transplantation.

Abstract

Donor BMI above 30 is generally considered contraindication for donor hepatectomy. We compared the donor outcomes based on BMI threshold and weight loss. All potential donors were identified and data were collected retrospectively. Steatosis was assessed based on liver-spleen Hounsfield unit difference and absolute liver intensity values. We compared BMI≥30 (n=53) and BMI<30 (n=64) donor outcomes. Donors with weight loss (WL) prior to surgery were also analyzed separately. Complications were graded by Clavien-Dindo classification. All donors underwent open right donor hepatectomy. There was no difference between BMI≥30 and<30 groups except female predominance in BMI≥30 group (P=.006). Both groups had similar rates of complication rates in all categories, similar remnant volume, operative time, length of stay and similar postoperative liver function recovery (all P>.05). On the other hand, donors with WL were more commonly male, had smaller graft size, and higher biliary complications rates compared to no-WL donors (all P<.05). Multivariate binary logistics regression analysis revealed no association between BMI or WL and outcomes. We demonstrate that donors with BMI≥30 have similar outcomes compared to BMI<30 donors with our defined selection criterion, therefore BMI≥30 is not an absolute contraindication to donate right liver, provided that there is no significant steatosis and remnant liver is satisfactory. For potential overweight donors, WL down to BMI<30 is a reasonable target. Higher biliary complication rates after WL should be investigated further.