S2332 The Impact of Body Mass Index (BMI) and Obesity on Liver Transplant Outcomes: A Retrospective Analysis of a Single Center 8-Year Experience

Introduction: Obesity is a growing global health challenge and a prevalent comorbidity in patients undergoing liver transplantation (LT). Its impact on post-transplant outcomes, including graft survival, rejection, and the need for transplantation, remains a topic of debate. We aimed to study the effects of obesity through body mass index (BMI) on LT outcomes. Methods: We conducted a retrospective chart review on patients 18 years and older who underwent liver transplant at our center between January 2015-January 2023. We categorized all the patients based on BMI (underweight, normal weight, overweight, obesity class 1, 2, or 3), and looked at multiple transplant outcomes, including mortality, episodes of rejection, need for re-transplantation, length of hospital stay following transplant, readmission rate within 1 year following transplant, emergent initiation of dialysis within 1 week of transplant, and graft failure. Results: A total of 807 patients underwent liver transplant, 526 were men (65%) and 667 were White (83%). The patients were then categorized into 6 BMI groups, with the overweight group being the most common (n = 273, 34%). BMI was not significantly associated with post-transplant mortality (P = 0.5), graft rejection (P = 0.6), readmissions (P = 0.9), emergent dialysis (P = 0.9), or length of hospital stay (P = 0.082). BMI was significantly associated with the need for re-transplantation (P = 0.026) and graft failure (P = 0.013). Adjusted analysis revealed that overweight (odds ratio [OR]: 0.34, 95% confidence interval [CI]: 0.12–0.87), Class I obesity (OR: 0.32, 95% CI: 0.10–0.91), and Class II obesity (OR: 0.19, 95% CI: 0.03–0.77) were associated with significantly lower odds of graft failure compared to normal weight. Class III obesity showed a trend toward increased risk of re-transplantation (OR: 3.60, 95% CI: 0.84–15.4), though this did not reach statistical significance. Conclusion: While extreme obesity may increase the risk of re-transplantation, overweight and moderate obesity were associated with lower odds of graft failure following liver transplantation. These findings suggest that BMI alone should not be a deterrent to transplantation candidacy.