Lin Jessica S, Muhammad Haris, Lin Timothy, Kamel Ihab, Baghdadi Azarakhsh, Rizkalla Nicole, Ottmann Shane E, Wesson Russell, Philosophe Benjamin, Gurakar Ahmet
Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, MD.
Transplant Direct. 2023 Jan 12;9(2):e1431. doi: 10.1097/TXD.0000000000001431. eCollection 2023 Feb.
Living liver donor obesity has been considered a relative contraindication to living donation given the association with hepatic steatosis and potential for poor donor and recipient outcomes. We investigated the association between donor body mass index (BMI) and donor and recipient posttransplant outcomes.
We studied 66 living donors and their recipients who underwent living donor liver transplant at our center between 2013 and 2020. BMI was divided into 3 categories (<25, 25-29.9, and ≥30 kg/m). Magnetic resonance imaging-derived proton density fat fraction was used to quantify steatosis. Donor outcomes included length of stay (LOS), emergency department visits within 90 d, hospital readmissions within 90 d, and complication severity. Recipient outcomes included LOS and in-hospital mortality. The Student test was used to compare normally distributed variables, and Kruskal-Wallis tests were used for nonparametric data.
There was no difference in donor or recipient characteristics based on donor BMI. There was no significant difference in mean magnetic resonance imaging fat percentage among the 3 groups. Additionally, there was no difference in donor LOS ( = 0.058), emergency department visits ( = 0.64), and hospital readmissions ( = 0.66) across BMI category. Donor complications occurred in 30 patients. There was no difference in postdonation complications across BMI category ( = 0.19); however, there was a difference in wound complications, with the highest rate being seen in the highest BMI group (0% versus 16% versus 37%; = 0.041). Finally, there was no difference in recipient LOS ( = 0.83) and recipient in-hospital mortality ( = 0.29) across BMI category.
Selecting donors with BMI ≥30 kg/m can result in successful living donor liver transplantation; however, they are at risk for perioperative wound complications. Donor counseling and perioperative strategies to mitigate wound-related issues should be used when considering obese living donors.
鉴于活体肝供体肥胖与肝脂肪变性相关，且可能导致供体和受体预后不良，一直被视为活体肝移植的相对禁忌证。我们研究了供体体重指数（BMI）与供体及受体移植后预后之间的关联。
我们研究了2013年至2020年期间在本中心接受活体肝移植的66名活体供体及其受体。BMI分为3类（<25、25 - 29.9和≥30kg/m²）。采用磁共振成像衍生的质子密度脂肪分数来量化脂肪变性。供体预后指标包括住院时间（LOS）、90天内急诊就诊次数、90天内再次入院次数以及并发症严重程度。受体预后指标包括住院时间和院内死亡率。采用Student t检验比较正态分布变量，采用Kruskal - Wallis检验分析非参数数据。
基于供体BMI，供体或受体特征无差异。3组间磁共振成像脂肪百分比均值无显著差异。此外，不同BMI类别供体的住院时间（P = 0.058）、急诊就诊次数（P = 0.64）和再次入院次数（P = 0.66）无差异。30例患者发生供体并发症。不同BMI类别供体术后并发症无差异（P = 0.19）；然而，伤口并发症存在差异，最高BMI组发生率最高（0%对16%对37%；P = 0.041）。最后，不同BMI类别受体的住院时间（P = 0.83）和受体院内死亡率（P = 0.29）无差异。
选择BMI≥30kg/m²的供体可成功进行活体肝移植；然而，他们存在围手术期伤口并发症风险。在考虑肥胖活体供体时，应采用供体咨询和围手术期策略来减轻与伤口相关的问题。
