Challenges and strategies for optimizing liver transplantation outcomes in morbidly obese cirrhotic patients: a narrative review

Abstract

The rising prevalence of morbid obesity (BMI > = 40) has introduced significant challenges in liver transplantation, particularly as metabolic dysfunction-associated steatohepatitis (MASH) becomes a leading cause of end-stage liver disease. Morbidly obese transplant candidates face higher perioperative complications, increased waitlist mortality, and worse post-transplant outcomes. This review explores these challenges and examines current strategies for managing morbid obesity in this population. Pre-operative weight loss and bariatric surgery prior to or in conjunction with transplantation have shown potential to improve eligibility and outcomes. Furthermore, emerging evidence suggests that BMI matching seems to influence graft function and survival. Finally, surgical techniques, such as robotic-assisted liver transplantation, while still novel and anecdotal, offer significant promise for reducing complications in this high-risk population.