title: Living donor liver transplantation in patients weighing ≥100 kg: Low graft weight and obesity do not impact outcomes.
abstract: Living donor liver transplantation (LDLT) in obese patients raises concerns with regards to obtaining grafts of "adequate" graft-to-recipient weight ratio (GRWR) and the impact of obesity on the outcomes of LDLT. LDLT outcomes in patients weighing ≥100 kg were compared with those weighing <100 kg. Patients weighing ≥100 kg were divided into 3 categories based on the GRWR of the grafts they received. Groups 1, 2, and 3 included patients with GRWR ≥0.8%, between 0.65% and 0.8%, and <0.65%, respectively. The 56 (6.5%) adult liver transplants were performed in patients weighing 100 kg or more. Except for higher mean body mass index (35.8 versus 25.2 kg/m2; P value < 0.01) and grafts of lower GRWR in obese patients (0.74% versus 1.02%; P value < 0.01), all other parameters were similar between the 2 groups. Despite obesity and smaller grafts, the posttransplant outcomes such as day to normal bilirubin and international normalized ratio; infective, respiratory, and biliary complications; and hospital mortality were similar between the 2 groups. On comparing obese patients in the 3 GRWR categories, except for graft weight (985 versus 769 versus 646 g; P value < 0.01), all the pretransplant parameters were comparable. There was no significant difference in terms of graft function, postoperative morbidity, and hospital mortality between patients with grafts of normal GRWR and those with grafts of low and very low GRWR. Grafts of low GRWR give satisfactory results in obese patients undergoing LDLT and obesity does not adversely impact the outcome of LDLT. Liver Transplantation 23:35-42 2017 AASLD.
authors.affiliation: Centre for Liver and Biliary Surgery, Indraprastha Apollo Hospital, Sarita Vihar, Delhi, India.
authors.forename: Shaleen
authors.initials: S
authors.lastname: Agarwal
authors.affiliation: Centre for Liver and Biliary Surgery, Indraprastha Apollo Hospital, Sarita Vihar, Delhi, India.
authors.forename: Neerav
authors.initials: N
authors.lastname: Goyal
authors.affiliation: Centre for Liver and Biliary Surgery, Indraprastha Apollo Hospital, Sarita Vihar, Delhi, India.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Nayeem
authors.affiliation: Centre for Liver and Biliary Surgery, Indraprastha Apollo Hospital, Sarita Vihar, Delhi, India.
authors.forename: Shishir
authors.initials: S
authors.lastname: Pareek
authors.affiliation: Centre for Liver and Biliary Surgery, Indraprastha Apollo Hospital, Sarita Vihar, Delhi, India.
authors.forename: Subash
authors.initials: S
authors.lastname: Gupta
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D064591:Allografts / Q000033:anatomy & histology*; D015992:Body Mass Index; D058625:End Stage Liver Disease / Q000150:complications / Q000601:surgery*; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology*; D006085:Graft Survival; D017052:Hospital Mortality; D006801:Humans; D008099:Liver / Q000033:anatomy & histology*; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D009929:Organ Size; D011184:Postoperative Period; D012189:Retrospective Studies; D012720:Severity of Illness Index; D066027:Transplant Recipients; D016896:Treatment Outcome; D055815:Young Adult