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Regional Variation in Utilization and Outcomes of Liver Allografts From Donors With High Body Mass Index and Graft Macrosteatosis

A Role for Liver Biopsy

Steggerda, Justin A., MD1; Kim, Irene K., MD2; Malinoski, Darren, MD3; Klein, Andrew S., MD2; Bloom, Matthew B., MD4

doi: 10.1097/TP.0000000000002379
Original Clinical Science—Liver

Background Obesity, defined as a high body mass index (hBMI) of 30 kg/m2 or greater, is a growing epidemic worldwide and is associated with multiple comorbidities. High BMI individuals account for an increasing portion of potential liver donors. Here we evaluate trends in the utilization and outcomes of hBMI donors on a national and regional level and the potential role of liver biopsy in donor evaluation.

Methods United Network for Organ Sharing Standard Transplant Analysis and Research database was evaluated for deceased donor liver transplants between 2006 and 2016 across 11 Organ Procurement and Transplantation Network regions. High BMI donors were compared with lower BMI counterparts and evaluated for biopsy rates, utilization rates and allograft outcomes. Univariate and multivariable analyses were performed.

Results Seventy-seven thousand fifty potential donors were identified and 60 200 transplants were evaluated. Utilization rates for hBMI donors were 66.1% versus 78.1% for lower BMI donors (P < 0.001). Pretransplant biopsy was performed more frequently in hBMI donors (52.1% vs 33.1%, P < 0.001) and macrosteatosis of 30% or greater was identified more often (21.1% vs 12.2%, P < 0.001). Biopsy performance increased utilization rate of hBMI donors in 7 of 11 Organ Procurement and Transplantation Network regions. region 6 showed the highest rate of biopsy performance, high rate of hBMI donor utilization, and highest 5-year estimated graft survival rates of all regions.

Conclusions High BMI donors have not previously been associated with worse graft survival in multivariable analyses; however, they are used much less frequently. Liver biopsy may increase the utilization rate of hBMI donors and improve donor selection. Further evaluation of regions with high rates of utilization and good outcomes is warranted.

1 Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.

2 Division of Transplantation, Cedars-Sinai Medical Center, Los Angeles, CA.

3 Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Oregon Health and Science University, Portland, OR.

4 Division of Trauma and Acute Care Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.

Received 14 March 2018. Revision received 14 June 2018.

Accepted 11 July 2018.

The authors declare no conflicts of interest.

J.A.S. contributed to the research design, data analysis, and writing/editing of the article. I.K.K. contributed to writing and editing of the article. D.M. contributed to the writing and editing of the article. A.S.K. contributed to the writing and editing of the manuscript. M.B.B. contributed to the research design and writing and editing of the article.

Correspondence: Justin Steggerda, MD, 8700 Beverly Blvd, Suite 8215, North Tower, Los Angeles, CA 90048. (Justin.Steggerda@cshs.org).

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.transplantjournal.com).

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