Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
October 14, 2026 · via Europe PMC
Changing national practice patterns in living donor BMI and liver biopsy utilization from 2000-2024.
Callans L, Byun L, Ng N, +6 more, Rosenblatt R.
AI summary — for doctors, generated from the abstract only
Donor and recipient BMI have risen over time in US living donor liver transplantation, yet donor obesity was not linked to worse recipient outcomes, and biopsy use has fallen sharply.
What was studied
A registry analysis (UNOS STAR file) of adult living donor liver transplant donors and recipients from 2000-2024, assessing BMI trends, liver biopsy utilization by donor obesity, center volume and region, and recipient outcomes including survival.
Key findings
- The analysis covered 7,942 donor-recipient pairs
- Recipient median BMI rose from 25.9 to 26.8 kg/m2 and donor BMI from 24.6 to 27.6 kg/m2
- Donor obesity was not associated with inferior recipient outcomes, while liver biopsy use declined substantially with persistent regional and center-level variation
Clinical relevance
The findings suggest that donor BMI of 30 kg/m2 or more need not automatically exclude a donor, and that standardizing steatosis assessment could widen the donor pool. Centers may wish to review how consistently they use biopsy.
Who should care
Limitations
The abstract is cut off in the results (the donor BMI p value and later results are missing), so detailed effect sizes for outcomes and biopsy rates cannot be stated. It is a retrospective registry analysis with no graft-specific outcomes or long-term steatosis data.
Donor obesity alone did not worsen recipient outcomes in this registry, but graft-specific and long-term data are still needed.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Background
Living donor liver transplantation (LDLT) remains an important alternative to deceased donor transplantation amid organ shortages. However, rising obesity may limits its growth through increased steatosis and decreased donor approval. We evaluated trends in donor and recipient BMI, liver biopsy utilization, and the association between donor obesity and recipient outcomes from 2000-2024.
Methods
Adult transplant recipients and donors from 2000-2024 were identified using the UNOS STAR file. Temporal BMI trends were assessed using annual percent change (APC). Liver biopsy utilization was evaluated overall and stratified by donor obesity status (BMI ≥30 kg/m2), center volume, and UNOS region. Secondary outcomes included length of stay and post-operative complications. Post-transplant survival was assessed using Cox proportional hazard models, with multivariable regression adjusting for a priori selected covariates.
Results
Among 7,942 donor-recipient pairs, recipient median BMI increased from 25.9 to 26.8 kg/m2, (APC 0.1%, p=0.01), while donor BMI increased from 24.6 to 27.6 kg/m2 (APC 0.4%, p<0.001). Despite increasing BMI, liver biopsy utilization declined from approximately 45%-50% in the mid-2000s to 6% by 2024 (APC -8.3%). Biopsy utilization remained higher among obese donors and declined more slowly (APC -5.8%). Donor BMI was not associated with transplant length of stay, post-operative complications (reoperation, vascular/biliary complications, readmissions), or post-transplant recipient survival (OR 1.00, 95% CI 0.99-1.01, p=0.42).
Conclusions
Donor and recipient BMI have both increased since 2000, yet donor obesity was not associated with inferior recipient outcomes. Liver biopsy utilization has declined substantially, with persistent regional and center-level variation. Standardization of steatosis assessment may help expand the living donor pool without compromising outcomes. Future studies should assess graft-specific outcomes and long-term steatosis recurrence.
DOI
10.1097/lvt.0000000000001020
PMID
42879422
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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