Outcomes of Simultaneous Liver-Kidney Transplants in Recipients with BMI Greater than 40 kg/m2

Background: Simultaneous liver-kidney (SLK) transplants across the country continues to rise. Studies associate higher kidney donor risk index (KDPI), MELD score, donation after cardiac death (DCD) to delayed graft function (DGF) in the renal allograft. DGF in turn increases risk of rejection, inferior patient and allograft survival. The risk of acute rejection and DGF in recipients with BMI >40 is twice compared to those with normal BMI. Hence we studied outcomes of BMI >40 SLK recipients at our institution and compared it to existing data. Methods: Data for SLK recipients (from 1/1/12019 to 12/30/2023) with BMI more than 40 including KDPI, Cold Ischemia time (CIT), donation after cardiac death or donation after brain death (DBD), MELD score at the time of surgery was collected. The outcomes studied include the rate of DGF, allograft survival at 1-year and patient survival at 1-year. We compared our 1 year results to the published data as shown in figure 1. Results: Median recipient BMI was 43.9, significantly higher than groups in comparison. All cohorts were similar in terms of median MELD, donor BMI and pre transplant renal replacement therapy. Despite decent allograft quality ( KDPI 65) we had worse allograft survival and more percentage of CKD4/5 recipients at 1year. Conclusion: The risk of acute rejection and DGF in recipients with BMI >40 is twice compared to those with normal BMI. A study at University of California showed sustained weight loss for patients who underwent sleeve gastrectomy prior to OLT, which was superior to medical weight loss. Spaggiari et al. showed benefits of Sleeve gastrectomy in kidney transplant. Obesity is the wellspring of NASH, DM, CKD and cardiovascular mortality. Hence, it’s time we incorporate timely referrals to promote weight optimization medically as well as surgically for our potential SLK recipients.