Alnagar Amr M T, Hajibandeh Shahab, Hajibandeh Shahin, Hakeem Abdul R, Dasari Bobby V M
Hepatobiliary and Pancreatic Surgery and Liver Transplant Unit, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom.
Department of Hepatobiliary and Pancreatic Surgery, University Hospital of Wales, Cardiff, United Kingdom.
Transplant Direct. 2024 Aug 29;10(9):e1656. doi: 10.1097/TXD.0000000000001656. eCollection 2024 Sep.
The effect of donor body mass index (BMI) on liver transplantation (LT) outcomes remains unclear.
A systematic search of the MEDLINE, CENTRAL, Web of Science, and bibliographic reference lists was conducted. All comparative studies evaluating the outcomes of LT in obese (BMI > 30 kg/m) and nonobese donors (BMI < 30 kg/m) were included, and their risk of bias was assessed using the ROBINS-I assessment tool. Patient and graft survival, acute rejection, and graft failure requiring retransplantation were evaluated as outcome parameters. A random-effects model was used for outcome synthesis.
We included 6 comparative studies reporting a total of 5071 liver transplant recipients from 708 obese and 4363 nonobese donors. There was no significant difference in 1-y (89.1% versus 84.0%, odds ratio [OR] 1.58; 95% CI 0.63-3.94, = 0.33), 5-y (74.2%% versus 73.5%, OR 1.12; 95% CI 0.45-2.80, = 0.81) graft survival, and 1-y (87.1% versus 90.3%, OR 0.71; 95% CI 0.43-1.15, = 0.17) and 5-y (64.5% versus 71.6%, OR 0.71; 95% CI 0.49-1.05, = 0.08) patient survival between 2 groups. Furthermore, recipients from obese and nonobese donors had a comparable risk of graft failure requiring retransplantation (OR 0.92; 95% CI 0.33-2.60, = 0.88) or acute graft rejection (OR 0.70; 95% CI 0.45-1.11, = 0.13).
A meta-analysis of the best available evidence (level 2a) demonstrates that donor obesity does not seem to have a negative impact on graft or patient outcomes. The available studies might be subject to selection bias as the grafts from obese donors are usually subject to biopsy to exclude steatosis and the recipients usually belong to the low-risk group. Future research is needed to evaluate the impact of donors subgrouped by various higher BMI on graft and patient-related outcomes as well as to capture data of the discarded grafts from obese donors; hence, selection criteria for the grafts that could be used for transplantation from obese donors is identified.
供体体重指数（BMI）对肝移植（LT）结局的影响尚不清楚。
对MEDLINE、CENTRAL、科学网和参考文献列表进行系统检索。纳入所有评估肥胖供体（BMI>30kg/m²）和非肥胖供体（BMI<30kg/m²）肝移植结局的比较研究，并使用ROBINS-I评估工具评估其偏倚风险。将患者和移植物存活率、急性排斥反应以及需要再次移植的移植物失败作为结局参数进行评估。采用随机效应模型进行结局综合分析。
我们纳入了6项比较研究，共报告了5071例肝移植受者，来自708例肥胖供体和4363例非肥胖供体。两组之间1年（89.1%对84.0%，优势比[OR]1.58；95%CI 0.63-3.94，P=0.33）、5年（74.2%对73.5%，OR 1.12；95%CI 0.45-2.80，P=0.81）移植物存活率，以及1年（87.1%对90.3%，OR 0.71；95%CI 0.43-1.15，P=0.17）和5年（64.5%对71.6%，OR 0.71；95%CI 0.49-1.05，P=0.08）患者存活率均无显著差异。此外，肥胖供体和非肥胖供体的受者发生需要再次移植的移植物失败（OR 0.92；95%CI 0.33-2.60，P=0.88）或急性移植物排斥反应（OR 0.70；95%CI 0.45-1.11，P=0.13）的风险相当。
对现有最佳证据（2a级）的荟萃分析表明，供体肥胖似乎对移植物或患者结局没有负面影响。现有研究可能存在选择偏倚，因为肥胖供体的移植物通常会进行活检以排除脂肪变性，且受者通常属于低风险组。未来需要开展研究，评估按不同较高BMI分组的供体对移植物和患者相关结局的影响，并收集肥胖供体废弃移植物的数据；从而确定可用于肥胖供体移植的移植物选择标准。
