Transplantation direct · 2026
The Impact of Donor-Recipient Weight Ratios and Body Surface Area Ratios on Outcomes After Adult Deceased Donor Whole-Liver Transplantation.
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McGeoghegan Patrick B, Miggins John J, Sugarbaker Evert, Quirarte Diego, Karla Anirudha, Lee Tzu-Hao, Cholankeril George, Goss John A, Rana Abbas
Аннотация
BACKGROUND: The impact of donor-recipient size mismatch on deceased donor whole-liver transplant (DDLT) outcomes remains underexplored. Weight ratio (WR) is a simple, readily available size-matching metric, whereas body surface area ratio (BSAR) requires additional calculations. We analyzed the impact of donor-recipient WR and BSAR on outcomes among adult DDLT recipients and compared their predictive abilities.
METHODS: We evaluated adult primary DDLTs in the United Network for Organ Sharing database from January 1, 2013, to January 1, 2024 (n = 69 511). Patients were divided into 5 WR and BSAR percentiles (<10th, 10th-20th, 20th-80th [reference], 80th-90th, and >90th). Cox models assessed associations with graft survival, patient survival, and length of stay (LOS). Kaplan-Meier and receiver operating characteristic (ROC) curves compared outcomes and predictive ability, respectively.
RESULTS: WR and BSAR both impacted outcomes. Lower percentiles were associated with modestly decreased graft and patient survival. Graft survival was decreased in the <10th WR percentile (WR ≤0.65; hazard ratio [HR], 1.13; 95% confidence interval [CI], 1.06-1.20; P < 0.001), 10th-20th WR percentile (0.65< WR ≤0.74; HR, 1.06; 95% CI, 1.01-1.13; P = 0.03), <10th BSAR percentile (BSAR ≤0.78; HR, 1.14; 95% CI, 1.08-1.21; P < 0.001), and 10th-20th BSAR percentile (0.78< BSAR ≤0.85; HR, 1.10; 95% CI, 1.04-1.16; P = 0.001). Only the <10th WR percentile was associated with worse patient survival (HR, 1.08; 95% CI, 1.01-1.15; P = 0.02), whereas both the <10th BSAR percentile and 10th-20th BSAR percentile were associated (HR, 1.09; 95% CI, 1.02-1.16; P = 0.007; HR, 1.07; 95% CI, 1.01-1.14; P = 0.02, respectively). Both <10th and >90th WR and BSAR percentiles prolonged LOS. ROC analysis revealed identical areas under the ROC curve for WR and BSAR, suggesting similar predictive ability (c-statistic = 0.62).
CONCLUSIONS: WR and BSAR are both reasonable tools to assess donor-recipient size matching in DDLT. Lower size-matching ratios increased graft failure and mortality, whereas both extremes prolonged LOS. Given its simplicity and immediate availability during donor evaluation, WR may serve as a practical adjunct for donor-recipient size matching. Caution is warranted with WR ≤0.74 or BSAR ≤0.85.
METHODS: We evaluated adult primary DDLTs in the United Network for Organ Sharing database from January 1, 2013, to January 1, 2024 (n = 69 511). Patients were divided into 5 WR and BSAR percentiles (<10th, 10th-20th, 20th-80th [reference], 80th-90th, and >90th). Cox models assessed associations with graft survival, patient survival, and length of stay (LOS). Kaplan-Meier and receiver operating characteristic (ROC) curves compared outcomes and predictive ability, respectively.
RESULTS: WR and BSAR both impacted outcomes. Lower percentiles were associated with modestly decreased graft and patient survival. Graft survival was decreased in the <10th WR percentile (WR ≤0.65; hazard ratio [HR], 1.13; 95% confidence interval [CI], 1.06-1.20; P < 0.001), 10th-20th WR percentile (0.65< WR ≤0.74; HR, 1.06; 95% CI, 1.01-1.13; P = 0.03), <10th BSAR percentile (BSAR ≤0.78; HR, 1.14; 95% CI, 1.08-1.21; P < 0.001), and 10th-20th BSAR percentile (0.78< BSAR ≤0.85; HR, 1.10; 95% CI, 1.04-1.16; P = 0.001). Only the <10th WR percentile was associated with worse patient survival (HR, 1.08; 95% CI, 1.01-1.15; P = 0.02), whereas both the <10th BSAR percentile and 10th-20th BSAR percentile were associated (HR, 1.09; 95% CI, 1.02-1.16; P = 0.007; HR, 1.07; 95% CI, 1.01-1.14; P = 0.02, respectively). Both <10th and >90th WR and BSAR percentiles prolonged LOS. ROC analysis revealed identical areas under the ROC curve for WR and BSAR, suggesting similar predictive ability (c-statistic = 0.62).
CONCLUSIONS: WR and BSAR are both reasonable tools to assess donor-recipient size matching in DDLT. Lower size-matching ratios increased graft failure and mortality, whereas both extremes prolonged LOS. Given its simplicity and immediate availability during donor evaluation, WR may serve as a practical adjunct for donor-recipient size matching. Caution is warranted with WR ≤0.74 or BSAR ≤0.85.