Association between pre-transplant body mass index and post-transplant infection and rejection in liver transplant recipients: A single-center retrospective cohort study

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Background The relationship between pre-transplant body mass index (BMI) and post-transplant outcomes remains a topic of interest in liver transplantation. This study aimed to investigate the association between pre-transplant BMI categories and the incidence of infections and graft rejection among liver transplant recipients. Methods The data for this study were obtained from a single-center LT database, consisting of 479 patients with ages >18 who underwent their first liver transplant during the period from May 2013 to September 2022. The patients were categorized into four groups based on their pre-transplant BMI: underweight (BMI < 18.5 kg/m²), normal weight (BMI from 18.5 to 24.9 kg/m²), overweight (BMI from 25 to 29.9 kg/m²), and obese (BMI ≥ 30 kg/m²). Results Out of the total 479 patients included in the study, 13.4% and 11.7% experienced infectious complications and graft rejection following their liver transplant, respectively. Obesity was observed in 18.2% of patients and 6.5% were classified as underweight. Although the underweight group exhibited the highest rates of complications, no statistically significant differences were found among the BMI categories (P = 0.152 for infections; P = 0.072 for graft rejection), even after adjusting for confounders such as age and sex. Conclusions In this study, pre-transplant BMI was not an independent predictor of post-transplant infections or graft rejection . While the underweight group displayed higher rates of infections and graft rejection, these differences were not statistically significant. Further research is needed to explore the complex mechanisms underlying these associations and to identify additional factors influencing post-transplant success.

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