Impact of donor obesity on paediatric liver transplantation; current evidence and potentials for graft pool expansion.

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.