Impact of donor BMI on donor safety and recipient survival in living liver transplantation: A propensity score matching analysis

Background The obesity pandemic has increased the consideration of obese donors in living donor liver transplantation (LDLT). While obese donors are thought to pose risks in LDLT, data considering regional differences remain insufficient. This study investigated the effects of donor obesity on donor safety and recipient outcomes using Asian-specific body mass index (BMI) criteria. Methods A retrospective analysis of 351 LDLT donors and their recipients was conducted. Donors were classified based on WHO Asia-Pacific BMI criteria: the standard group (BMI ≤22.9 kg/m 2 ) and the overweight and obese (OAO) group (BMI 23.0–27.4 kg/m 2 and ≥27.5 kg/m 2 ). Both donor and recipient short- and long-term outcomes were compared before and after propensity score matching (PSM). Results Among the donors, 31.6 % were overweight and 4.3 % were obese. BMI correlated positively with operation time (r = 0.191) and intraoperative blood loss (r = 0.194), particularly in right lobectomy donors. After PSM, adjusting for donor age, gender, and surgical procedure, operation time did not differ significantly between groups (P = 0.093). The OAO group had greater blood loss (P = 0.014), which became nonsignificant after weight adjustment (P = 0.509). There were no significant differences in donor complication rates or recipient short-term outcomes. Graft survival (P = 0.632) and recipient survival times (P = 0.803) were comparable between the groups. Conclusion Higher BMI in donors is associated with potentially increased perioperative risks but does not negatively impact long-term recipient survival. Careful donor selection and perioperative management can make overweight and obese individuals viable donors.