The effect of donor body mass index on primary graft nonfunction, retransplantation rate, and early graft and patient survival after liver transplantation.

Abstract

Previous studies have suggested that moderate donor liver steatosis is associated with an increased incidence of primary graft nonfunction (PGNF), delayed graft function, early graft loss, and retransplantation rates. The objective of our study was to determine the effect of donor body mass index (dBMI), after adjusting for other known confounding variables, on PGNF, early graft failure, retransplantation rate, and patient survival. The United Network for Organ Sharing (UNOS) database (1987 to 2001) of 22,303 adult patients, excluding patients of pediatric age (age less than 18 years) and those with multiple organ transplantations, living donors, and retransplantations, was used for this study. Based on the BMI (kg/m(2)) of the organ donor, transplant recipients were divided into four groups as follows: BMI < 25 (group 1, n = 11,660), 25 to 29.9 (group 2, n = 7418), 30 to 34.9 (group 3, n = 2301), and > or = 35 (group 4, n = 924). Information on donor liver histology was available for 1603 patients who underwent transplantation after 1999, and this subgroup was divided into three groups based on severity of steatosis (group A, < 20%; group B, 20% to 35%; group C, > 35%). Incidence of PGNF and early retransplantation rates were similar in groups 1 to 4 and in groups A, B, and C. Logistic regression analysis showed that dBMI or severity of steatosis was not a predictor of PGNF and early retransplantation. Cox regression analysis, after adjusting for confounding variables, showed similar patient and graft survival at 1 month and 1, 2, and 5 years for groups 1 to 4, and at 1 month and 6 months for groups A, B, and C. Severe donor obesity or moderate steatosis did not influence short-term and long-term outcome of liver transplantation.