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The Impact of Donor-Recipient Weight Ratios and Body Surface Area Ratios on Outcomes After Adult Deceased Donor Whole-Liver Transplantation

Year: 2026

Type: article

Abstract: 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: = 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.

Source: Transplantation Direct

DOI: 10.1097/txd.0000000000001991