{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T13:21:25Z","timestamp":1788355285954,"version":"build-2803163510"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","license":[{"start":{"date-parts":[[2009,8,1]],"date-time":"2009-08-01T00:00:00Z","timestamp":1249084800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2009,7,29]],"date-time":"2009-07-29T00:00:00Z","timestamp":1248825600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2009,8]]},"abstract":"<jats:sec>\n            <jats:title\/>\n            <jats:p>Controversies exist regarding the morbidity and mortality of patients undergoing liver transplantation at the extremes of the body mass index (BMI). A review of the United Network for Organ Sharing database from 1987 through 2007 revealed 73,538 adult liver transplants. Patients were stratified into 6 BMI categories established by the World Health Organization: underweight, &lt;18.5 kg\/m<jats:sup>2<\/jats:sup>; normal weight, 18.5 to &lt;25 kg\/m<jats:sup>2<\/jats:sup>; overweight, 25 to &lt;30 kg\/m<jats:sup>2<\/jats:sup>; obese, 30 to &lt;35 kg\/m<jats:sup>2<\/jats:sup>; severely obese, 35 to &lt;40 kg\/m<jats:sup>2<\/jats:sup>; and very severely obese, \u226540 kg\/m<jats:sup>2<\/jats:sup>. Survival rates were compared among these 6 categories via Kaplan-Meier survival curves with the log-rank test. The underweight and very severely obese groups had significantly lower survival. There were 1827 patients in the underweight group, 1447 patients in the very severely obese group, and 68,172 patients in the other groups, which became the control. Groups with extreme BMI (&lt;18.5 and \u226540) were compared to the control to assess significant differences. Underweight patients were more likely to die from hemorrhagic complications (<jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.002) and cerebrovascular accidents (<jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.04). When compared with the control, the very severely obese patients had a higher number of infectious complications and cancer events (<jats:italic toggle=\"yes\">P<\/jats:italic> = 0.02) leading to death. In 3 different eras of liver transplantation, multivariable analysis showed that underweight and very severe obesity were significant predictors of death. In conclusion, liver transplantation holds increased risk for patients at the extremes of BMI. Identifying these patients and instituting aggressive new policies may improve outcomes. 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