High body mass index at liver transplantation: A retrospective single-center analysis of blood product utilization and postoperative outcomes.

Obesity, generally defined as high body mass index (BMI), is increasingly prevalent in liver transplant recipients, but its impact on perioperative management is still not understood. This study aimed to examine intraoperative transfusion as a marker of surgical complexity, alongside blood loss, ventilation duration, and intensive care unit length of stay. We conducted a retrospective single-center analysis of adult liver transplant recipients between June 1, 2012, and March 31, 2024. Data were extracted from electronic medical records and stratified by BMI to compare demographics, clinical characteristics, intraoperative variables, and postoperative outcomes. Among 1444 recipients, patients with a BMI of ≥40 kg/m² required significantly more units of blood products (median, 20 units; IQR, 12-32 units) than normal/overweight patients (median, 12 units; IQR, 6-20 units; P < .001). They had greater blood loss, longer ventilation times, and extended intensive care unit stays (all P < .001). This is the first study to assess granular intraoperative data on blood product use, acute kidney injury, and extubation in liver transplant recipients with a BMI of ≥40 kg/m². It shows that a BMI of ≥40 kg/m² is linked to increased perioperative resource utilization and longer hospital stays. Importantly, patients with a BMI of ≥40 kg/m² have equivalent long-term outcomes after liver transplant. BMI should be used with extreme caution in candidacy decisions.