S2646 Is BMI an Independent Risk Factor for Post-Liver Transplant Outcomes?

Introduction: Understanding the role of body mass index (BMI) as an independent risk factor for post-liver transplant outcomes is crucial in optimizing patient management. This study examines the association between BMI and key transplant-related outcomes. Methods: A retrospective cohort analysis was conducted using the UMMC liver transplant database (2016–2018). Patients were stratified into BMI categories: underweight (BMI <18.5), normal weight (BMI 18.5–24.9), overweight (BMI 25–29.9), and obese (BMI ≥30). Outcomes analyzed were acute cellular rejection, biliary strictures, and all-cause mortality. Adjusted hazard ratios (HRs) were calculated for each outcome, controlling for age, sex, and race. Results: Among 323 patients, BMI was not independently associated with acute rejection, or biliary strictures. Also, mortality rates across BMI categories showed no significant differences, with adjusted HRs of 1.02 (underweight), 0.68 (overweight), and 0.98 (obese) relative to normal weight. Obese patients had longer ICU stays and higher incidence of ERCP utilization but comparable biliary stricture rates. While aspartate aminotransferase and alanine aminotransferase levels were highest among overweight patients, 1-year graft function outcomes were not significantly different across BMI groups. Conclusion: BMI does not independently predict most common adverse post-transplant outcomes, including mortality, rejection, or biliary strictures, but BMI ≥30 is associated with higher ICU stay and ERCP utilization. These findings suggest BMI alone should not guide transplant eligibility but may impact healthcare.