National-Level Prevalence of Overweight and Obesity Among Liver Transplant Recipients in the USA, 1988–2022, and Projections to 2050

Background/Objectives: As indications of liver transplantation evolve and the burden of obesity rises in the general population, a clear understanding of weight trends among liver transplant (LT) recipients is needed to inform evidence-based guidance for obesity prevention and management across the transplant continuum. The objective of this study was to characterize national trends in body mass index (BMI) among adult liver transplant recipients and to project future trajectories, with attention to key demographic and disease-related subgroups. Methods: Using national-level data on 176,891 LT recipients from the United Network for Organ Sharing (UNOS)/Organ Procurement and Transplantation Network (OPTN) database between 1988 and 2022, we analyzed trends in BMI among adult LT recipients, applying linear regression to evaluate temporal trends and identify changes in trajectories. We stratified results by sex, race/ethnicity, age, and liver disease etiology, and derived BMI projections until 2050. Results: We observed that from 1988 to 2022, the mean BMI increased from 24.7 kg/m2 (representing normal weight) to 28.9 kg/m2 (representing overweight) (p < 0.001). There was a significant decline in the number of LT recipients classified as underweight or normal weight, with a reciprocal increase in overweight and all obesity categories. Based on current trends, the mean BMI of LT recipients is projected to reach 30.1 kg/m2 (representing class I obesity) by 2050. Conclusions: Overall, overweight and obesity rates among adult LT recipients have risen dramatically over three decades. Effective prevention and treatment strategies for excess weight are much needed before and after LT.