Impact of Donor Obesity on Outcomes in Living Donor Liver Transplantation: A Systematic Review and Meta-analysis

Background. Living donor liver transplantation increasingly faces the question of whether otherwise healthy candidates with a body mass index ≥30 kg/m 2 can be safely accepted. Available evidence is uneven: large registry datasets sit alongside heterogeneous single-center series, none quantifying the risk accepted by the donors themselves. We therefore synthesized contemporary comparative evidence in living donor liver transplantation, evaluating donor obesity against donor, recipient, and graft outcomes. Methods. We searched PubMed/MEDLINE, Cochrane Library, Scopus, Web of Science, and Google Scholar from January 2000 to June 30, 2026, for comparative cohorts of living liver donors reporting donor and recipient outcomes by donor body mass index (≥30 versus <30 kg/m 2 ). Random-effects meta-analysis used restricted maximum likelihood with Hartung-Knapp-Sidik-Jonkman 95% confidence intervals (CIs); risk of bias and certainty of evidence were assessed with Risk Of Bias In Nonrandomized Studies of Interventions and Grading of Recommendations, Assessment, Development, and Evaluation. Results. Nine comparative cohorts comprising 6652 donors from North America, Europe, and Asia were included. Donor obesity was not associated with overall complications (risk ratio [RR], 1.09; 95% CI, 0.89-1.34; P = 0.31) or major complications (RR, 1.02; 95% CI, 0.62-1.67; P = 0.93). However, obese donors had higher rates of wound complications (RR, 2.05; 95% CI, 1.25-3.37; P = 0.012) and hospital readmission (RR, 1.34; 95% CI, 1.07-1.69; P = 0.026). Recipient 1-y patient survival, graft survival, and biliary complications were comparable. Conclusions. In carefully screened candidates, obesity alone should not preclude living liver donation. The excess wound morbidity and readmission argue for enhanced prophylaxis and surveillance after discharge rather than for donor exclusion.