Alnagar A, Amgad A, Grammatikopoulos T, Kyrana E. Impact of donor obesity on paediatric liver transplantation; current evidence and potentials for graft pool expansion. World J Transplant 2025; 15(3): 103015 [DOI: 10.5500/wjt.v15.i3.103015]
Corresponding Author of This Article
Amr Alnagar, PhD, Department of General Surgery, University Hospitals of Birmingham, 6 Chamberlain Road, Birmingham B13 0QB, United Kingdom. amr.alnagar@nhs.net
Research Domain of This Article
Transplantation
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Sep 18, 2025; 15(3): 103015 Published online Sep 18, 2025. doi: 10.5500/wjt.v15.i3.103015
Impact of donor obesity on paediatric liver transplantation; current evidence and potentials for graft pool expansion
Amr Alnagar, Ahmed Amgad, Tassos Grammatikopoulos, Eirini Kyrana
Amr Alnagar, Department of General Surgery, University Hospitals of Birmingham, Birmingham B13 0QB, United Kingdom
Ahmed Amgad, Faculty of Medicine, Helwan University, Cairo 4034572, Al Qāhirah, Egypt
Tassos Grammatikopoulos, Department of Paediatric Liver, GI and Nutrition, King's College Hospital, London SE5 9RS, United Kingdom
Eirini Kyrana, Roger Williams Institute of Liver Studies, King's College London, London SE5 9NT, United Kingdom
Co-first authors: Amr Alnagar and Ahmed Amgad.
Author contributions: Alnagar A and Amgad A designed the study, conducted the literature review, and wrote the manuscript draft; they contribute equally to this study as co-first authors; Grammatikopoulos T and Kyrana E performed the critical revision and final drafting of the manuscript.
Conflict-of-interest statement: The authors have no conflicts of interest to declare that are relevant to the content of this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Amr Alnagar, PhD, Department of General Surgery, University Hospitals of Birmingham, 6 Chamberlain Road, Birmingham B13 0QB, United Kingdom. amr.alnagar@nhs.net
Received: November 5, 2024 Revised: March 12, 2025 Accepted: March 26, 2025 Published online: September 18, 2025 Processing time: 164 Days and 12.2 Hours
Abstract
Paediatric liver transplantation (PLT) is a life-saving procedure for children with advanced liver disease or hepatoblastoma. The number of available grafts is limited in relation to the number of children on PLT waiting list. This graft shortage has led transplant societies and healthcare organizations to explore ways to investigate possible options and expand the donor pool. The safe use of grafts from obese donors has always been a subject of debate among PLT specialists. Donors’ obesity is strongly associated with hepatic steatosis which can affect graft function by impairing microcirculation and maximizing the potential of ischemia-reperfusion injury. Donor body mass index consideration should go hand in hand with the workup for hepatic steatosis which is an independent predictor for early graft dysfunction. New strategies to optimize the grafts before PLT such as normothermic regional perfusion and ex vivo liver perfusion can potentially mitigate the risk of using grafts from obese donors. This review summarizes the available evidence about the impact of donor obesity on PLT and highlights the current policies to widen the graft pool and suggest future research directions to improve donor selection and patient outcomes.
Core Tip: Paediatrics liver transplantation is primarily dependent on graft availability. Currently there is a gap between is the available grafts and number of children on transplant waiting list resulting in graft shortage. Grafts from obese donors has the risk of hepatic steatosis which could negatively impact transplantation outcomes. Donor obesity should not substitute steatosis work-up as the latter is viewed as independent predictor of graft dysfunction. New strategies to optimize grafts before transplantation might within limits mitigate the risk of using grafts from obese donors.
