Impact of body mass index on outcomes of 48281 patients undergoing first time cadaveric liver transplantation

Table 1 Demographic and clinical characteristics of the study population

		WHO BMI classification						P value
					Obese recipients
Variable	Total number of patients (n = 48281) (100%)	Underweight (n = 914) (1.9%)	Normal weight (n = 14529) (30.0%)	Overweight (n = 16724) (34.6%)	Class I (n = 9944) (20.5%)	Class II (n = 4438) (9.2%)	Class III (n = 1732) (3.5%)
Age in years, median (25th, 75th)	53 (46, 59)	50 (40, 57.2)	52 (44, 58)	53 (46, 58)	53 (46, 58)	53 (46, 58)	52 (47, 58)	0.000
Gender, n (%)
Male	30250 (62.7)	407 (44.5)	8573 (59.0)	11336 (67.8)	6489 (65.3)	2609 (58.8)	836 (48.3)	0.000
Female	18.031 (37.3)	507 (55.5)	5956 (41.0)	5388 (32.2)	3455 (34.7)	1829 (41.2)	896 (51.7)
Recipient living status, n (%)
Alive	27552 (57.1)	496 (54.3)	8040 (55.4)	9534 (57.1)	5825 (58.6)	2642 (59.6)	1015 (58.6)	0.000
Dead	16689 (34.6)	346 (37.9)	5123 (35.3)	5804 (34.7)	3344 (33.7)	1471 (33.2)	601 (34.7)
Lost at follow-up	3987 (8.3)	72 (7.9)	1348 (9.3)	1370 (8.2)	765 (7.7)	317 (7.2)	115 (6.6)
Race, n (%)
Non-hispanic white	36809 (76.2)	664 (72.6)	10850 (74.7)	12820 (76.7)	7687 (77.3)	3475 (78.3)	1313 (75.8)	0.000
Non-hispanic black	3962 (8.2)	92 (10.1)	1237 (8.5)	1277 (7.6)	815 (8.2)	371 (8.4)	170 (9.8)
Hispanic	5535 (11.5)	73 (8.0)	1534 (10.6)	2020 (12.1)	1191 (12.0)	500 (11.3)	217 (12.5)
Asian	1446 (3.0)	78 (8.5)	782 (5.4)	415 (2.5)	131 (1.3)	30 (0.7)	10 (0.6)
Other	529 (1.1)	7 (0.7)	126 (0.8)	192 (1.1)	120 (1.2)	62 (1.3)	22 (1.2)
Recipient BMI, median (25th, 75th)	27.05 (23.8, 31.1)	17.63 (17.0, 18.1)	22.73 (21.2, 23.9)	27.26 (26.0, 28.5)	32.01 (30.3, 33.3)	36.85 (35.8, 38.1)	42.24 (41.1, 44.2)	0.000
Primary indication for liver transplantation, n (%)
HCV	13838 (28.7)	176 (19.3)	3538 (24.4)	5248 (31.4)	3101 (31.2)	1302 (29.3)	473 (27.3)	0.000
Alcohol	8111 (16.8)	163 (17.8)	2543 (17.5)	2909 (17.4)	1686 (17.0)	622 (14.0)	188 (10.9)
Idiopathic	5073 (10.5)	77 (8.4)	1179 (8.1)	1656 (9.9)	1270 (12.8)	628 (14.2)	263 (15.2)
Alcohol + HCV	3601 (7.5)	44 (4.8)	1033 (7.1)	1370 (8.2)	762 (7.7)	310 (7.0)	82 (4.7)
PSC	2799 (5.8)	101 (11.1)	1396 (9.6)	903 (5.4)	282 (2.8)	92 (2.1)	25 (1.4)
Congenital/metabolic disease	2567 (5.3)	80 (8.8)	870 (6.0)	826 (4.9)	455 (4.6)	215 (4.8)	121 (7.0)
PBC	2485 (5.1)	92 (10.1)	1122 (7.7)	765 (4.6)	342 (3.4)	116 (2.6)	48 (2.8)
NASH	2247 (4.7)	13 (1.4)	226 (1.6)	585 (3.5)	660 (6.6)	522 (11.8)	241 (13.9)
HBV	1896 (3.9)	33 (3.6)	798 (5.5)	646 (3.9)	291 (2.9)	92 (2.1)	36 (2.1)
Other	5664 (11.7)	135 (14.7)	1824 (12.5)	1816 (10.8)	1095 (11.0)	539 (12.1)	291 (14.7)
MELD score, median (25th, 75th)	21 (16, 28)	22 (16, 28)	21 (16, 29)	20 (15, 28)	21 (16, 28)	21 (15, 29)	22 (16, 31)	0.000
Cold ischemia time, hours, median (25th, 75th)	7.0 (5.4, 9.2)	7.1 (5.3, 9.0)	7.0 (5.3, 9.1)	7.0 (5.3, 9.1)	7.1 (5.4, 9.2)	7.2 (5.5, 9.3)	7.3 (5.7, 9.4)	0.288
Warm ischemia time, minutes, median (25th, 75th)	44 (34, 55)	44 (35, 55)	43 (34, 55)	44 (35, 55)	44 (35, 56)	45 (35, 57)	41 (31, 50)	0.000
Waiting time, days (including days on hold), median (25th, 75th)	120 (27, 335)	91 (21, 286)	106 (24, 308)	124 (28, 336)	131 (30, 358)	134 (31, 355.5)	86 (12, 314)	0.000
Hospital stay after liver transplant, days, median (25th, 75th)	11 (8, 19)	13 (7, 23)	11 (8, 19)	11 (8, 18)	11 (8, 18)	12 (8, 19)	13 (9, 22)	0.000
Preoperative comorbidities, n (%)
Diabetes type I	536 (1.1)	9 (1.7)	108 (0.8)	181 (1.1)	155 (1.6)	60 (1.4)	23 (1.3)	0.000
Diabetes type II	8541 (18.0)	81 (9.1)	1827 (12.9)	2896 (17.6)	2179 (22.2)	1105 (25.2)	453 (26.6)
Dialysis	3538 (7.3)	80 (8.8)	1059 (7.3)	1160 (6.9)	693 (7.0)	366 (8.2)	180 (5.1)	0.000
Hypertension	4124 (8.5)	54 (5.9)	989 (6.8)	1424 (8.5)	990 (10.0)	481 (10.8)	186 (10.7)	0.000
Chronic obstructive pulmonary disease	447 (0.9)	13 (1.4)	133 (0.9)	153 (0.9)	86 (0.9)	45 (1.0)	17 (1.0)	0.000

HCV: Hepatitis C virus; HBV: Hepatitis B virus; PSC: Primary sclerosing cholangitis; NASH: Non-alcoholic steatohepatitis; BMI: Body mass index; WHO: World Health Organization; MELD: Model for End-Stage Liver Disease; PBC: Primary biliary cirrhosis.

Table 2 Donor demographic and clinical characteristics

		WHO recipients’ BMI						P value
					Obese recipients
Donor variable	Total number of donors (n = 48281) (100%)	Underweight (n = 914) (1.9%)	Normal weight (n = 14529) (30.0%)	Overweight (n = 16724) (34.6%)	Class I (n = 9944) (20.5%)	Class II (n = 4438) (9.2%)	Class III (n = 1732) (3.5%)
Age in years, median (25th, 75th)	40 (24, 53)	37 (20, 52)	39 (22, 53)	40 (24, 53)	41 (24, 53)	41 (25, 53)	41 (25, 54)	0.000
BMI, median (25th, 75th)	25.2 (22.3, 29.0)	23.6 (20.7, 27.1)	24.6 (21.7, 28.2)	25.3 (22.3, 29.0)	25.7 (22.7, 29.8)	25.9 (23.0, 29.9)	25.8 (22.8, 30.0)	0.000
Gender, n (%)
Male	29034 (60.1)	486 (53.2)	8171 (56.2)	10219 (61.1)	6280 (63.2)	2801 (63.1)	1077 (62.2)	0.000
Female	19247 (39.8)	428 (46.8)	6358 (43.8)	6505 (38.9)	3664 (36.8)	1637 (36.9)	655 (37.8)
Primary cause of death, n (%)
Anoxia	6895 (14.3)	163 (17.8)	2004 (13.8)	2337 (33.9)	1465 (14.7)	675 (15.2)	251 (14.5)	0.040
Cerebrovascular	19840 (41.1)	355 (38.8)	5980 (41.2)	6869 (41.1)	4079 (41.0)	1826 (41.1)	731 (42.3)
Head trauma	20273 (42.0)	372 (40.7)	6161 (42.4)	7098 (42.5)	4110 (41.4)	1831 (41.3)	701 (40,5)
Central nervous system tumor	357 (0.7)	8 (0.9)	107 (0.7)	116 (0.7)	92 (0.9)	24 (0.5)	10 (0.6)
Other	892 (1.8)	16 (1.8)	272 (1.9)	292 (1.7)	193 (1.9)	82 (1.8)	37 (2.1)
Race, n (%)
Non-hispanic white	34907 (72.3)	639 (69.9)	10488 (72.2)	12078 (72.2)	7196 (72.4)	3264 (73.5)	1242 (71.7)	0.000
Non-hispanic black	6758 (14.0)	127 (13.9)	1938 (13.3)	2334 (14.0)	1458 (14.7)	640 (14.4)	261 (15.1)
Hispanic	5118 (10.6)	109 (11.9)	1623 (11.2)	1790 (10.7)	994 (10.0)	427 (9.6)	175 (10.1)
Asian	885 (1.8)	28 (3.1)	299 (2,1)	309 (1.8)	162 (1,6)	55 (1.2)	32 (1.8)
Other	673 (1.3)	11 (1.2)	241 (1.6)	213 (1.2)	134 (1.3)	52 (1.1)	22 (1.2)

BMI: Body mass index; WHO: World Health Organization.

Table 3 Mean and median overall survival by recipients' body mass index class

	Means and medians for survival time (yr)
Recipient’s BMI	Mean1				Median
	Estimate	Std. error	95%CI		Estimate	Std. error	95%CI
			Lower bound	Upper bound			Lower bound	Upper bound
Underweight	10.8	0.3	10.2	11.4	11.5	0.6	10.4	12.7
Normal	11.6	0.1	11.4	11.7	13.1	0.2	12.6	13.6
Overweight	11.5	0.1	11.4	11.7	12.8	0.2	12.5	13.2
Obese-class I	11.3	0.1	11.2	11.5	12.4	0.2	11.9	12.8
Obese-class II	11.1	0.1	10.8	11.4	12.2	0.3	11.6	12.9
Obese-class III	10.7	0.2	10.2	11.1	11.3	0.5	10.3	12.3
Overall	11.5	0.0	11.4	11.5	12.7	0.1	12.5	12.9

¹Estimation is limited to the largest survival time if it is censored. BMI: Body mass index.

Table 4 Univariate and multivariate Cox analysis of predictors of overall survival

	Univariate analysis		Multivariate analysis
Variable	Hazard rate (95%CI)	P value	Hazard rate (95%CI)	P value
Recipient BMI		0.003		0.000
Normal weight (reference)	1		1
Underweight	1.125 (1.009-1.255)	0.034	1.265 (1.096-1.461)	0.001
Overweight	1.005 (0.968-1.043)	0.807	0.908 (0.864-0.954)	0.000
Obese class I	1.024 (0.980-1.070)	0.284	0.947 (0.893-1.004)	0.067
Obese class II	1.042 (0.983-1.104)	0.169	0.971 (0.898-1.051)	0.470
Obese class III	1.163 (1.069-1.266)	0.000	1.157 (1.031-1.299)	0.013
Donor BMI		0.001		0.000
Normal weight (reference)	1		1
Underweight	0.962 (0.897-1.033)	0.288	1.017 (0.928-1.114)	0.716
Overweight	1.060 (1.023-1.098)	0.001	1.009 (0.962-1.057)	0.717
Obese class I	1.049 (0.998-1.102)	0.059	0.986 (0.921-1.057)	0.695
Obese class II	1.129 (1.045-1.220)	0.002	1.020 (0.912-1.140)	0.729
Obese class III	0.988 (0.999-1.112)	0.988	0.889 (0.765-1.034)	0.128
Recipient age		0.000		0.000
18-45 (reference)	1		1
46-55	1.264 (1.212-1.319)	0.000	1.207 (1.143-1.276)	0.000
56-65	1.536 (1.471-1.603)	0.000	1.490 (1.405-1.580)	0.000
66-75	2.005 (1.887-2.130)	0.000	2.069 (1.904-2.247)	0.000
≥ 76	3.224 (2.099-4.951)	0.000	2.476 (1.462-4.194)	0.001
Donor age		0.000		0.000
0-17 (reference)	1		1
18-45	1.107 (1.050-1.166)	0.000	1.066 (0.996-1.141)	0.066
46-55	1.297 (1.223-1.376)	0.000	1.266 (1.170-1.370)	0.000
56-65	1.502 (1.411-1.598)	0.000	1.413 (1.300-1.537)	0.000
66-75	1.706 (1.583-1.840)	0.000	1.609 (1.453-1.782)	0.000
≥ 76	1.661 (1.448-1.883)	0.000	1.609 (1.340-1.932)	0.000
Recipient sex (male)	1.063 (1.030-1.097)	0.000	1.025 (0.979-1.073)	0.297
Donor sex (male)	0.951 (0.922-0.980)	0.001	0.967 (0.926-1.008)	0.967
Cold ischemia time (h)	1.010 (1.006-1.013)	0.000	1.008 (1.003-1.013)	0.001
Warm ischemia time (min)	1.002 (1.001-1.003)	0.000	1.002 (1.001-1.003)	0.000
Year of transplantation	0.996 (0.992-0.999)	0.017	0.987 (0.980-0.993)	0.000
Dialysis	1.507 (1.422-1.598)	0.000	1.492 (1.367-1.629)	0.000
Diabetes	1.406 (1.355-1.460)	0.000	1.314 (1.248-1.383)	0.000
COPD	1.384 (1.218-1.573)	0.000	1.250 (1.075-1.454)	0.004
Hypertension	1.207 (1.150-1.267)	0.000	1.057 (0.998-1.120)	0.059
Primary indication		0.000		0.000
HCV	1.356 (1.313-1.400)	0.000	1.429 (1.335-1.530)	0.000
Alcohol + HCV	1.214 (1.152-1.281)	0.000	1.477 (1.351-1.616)	0.000
HCV + other viral hepatitis	1.093 (0.932-1.283)	0.274	1.342 (1.098-1.638)	0.004
Other	1.020 (0.951-1.094)	0.583	1.111 (0.993-1.244)	0.067
Alcohol	1.060 (1.018-1.103)	0.005	1.188 (1.102-1.282)	0.000
HBV	0.669 (0.613-0.729)	0.000	0.782 (0.691-0.883)	0.000
PSC	0.597 (0.554-0.644)	0.000	0.709 (0.634-0.792)	0.000
PBC	0.670 (0.623-0.721)	0.000	0.715 (0.641-0.797)	0.000
NASH	0.906 (0.821-1.001)	0.051	0.953 (0.783-1.160)	0.630
Autoimmune	0.807 (0.742-0.878)	0.000	0.916 (0.810-1.036)	0.164
Acute liver failure	0.801 (0.689-0.931)	0.004	1.049 (0.822-1.339)	0.701
Congenital or metabolic disease	0.758 (0.703-0.817)	0.000	0.825 (0.736-0.926)	0.001

At multivariate analysis, after adjusting for patients’ and donors’ characteristics, primary indication for liver transplantation, comorbidities, year of transplantation and warm and cold ischemia times, class III obesity and underweight status remained independent factors associated with lower survival. HCV: Hepatitis C virus; HBV: Hepatitis B virus; PSC: Primary sclerosing cholangitis; NASH: Non-alcoholic steatohepatitis; BMI: Body mass index; COPD: Chronic obstructive pulmonary disease; PBC: Primary biliary cirrhosis.

Table 5 Mean and median graft survival by recipients' body mass index class

	Means and medians for graft survival time (yr)
Recipient’s BMI	Mean1				Median
	Estimate	Std. error	95%CI		Estimate	Std. error	95%CI
			Lower bound	Upper bound			Lower bound	Upper bound
Underweight	10.4	0.3	9.8	11	11.1	0.4	10.1	12.1
Normal	11.1	0.07	10.9	11.3	12	0.2	11.6	12.5
Overweight	11.1	0.07	11	11.3	12	0.1	11.6	12.4
Obese-class I	11	0.09	10.8	11.2	11.7	0.2	11.3	12.1
Obese-class II	10.8	0.14	10.5	11.1	11.7	0.3	11.1	12.3
Obese-class III	10.3	0.24	9.8	10.8	10.7	0.5	9.7	11.7
Overall	11	0.04	11	11.1	11.8	0.1	11.6	12

¹Estimation is limited to the largest survival time if it is censored. BMI: Body mass index.

Table 6 Summary of the primary causes of graft loss stratified by recipients' body mass index n (%)

		WHO recipients’ BMI class						P value
					Obese recipients
	All recipients (n = 16715)	Underweight (n = 346)	Normal weight (n = 5129)	Overweight (n = 5813)	Class I (n = 3351)	Class II (n = 1473)	Class III (n = 603)
Primary cause of graft failure		(I)	(II)	(III)	(IV)	(V)	(VI)
Primary graft non-function	603 (3.6)	11 (3.2)	178 (3.5)	221 (3.8)	128 (3.8)	48 (3.3)	17 (2.8)	≥ 0.05
Biliary complications	89 (0.5)	2 (0.6)	18 (0.4)	34 (0.6)	23 (0.7)	6 (0.4)	6 (1.0)	≥ 0.05
Vascular thrombosis	119 (0.7)	2 (0.6)	45 (0.9)	39 (0.7)	16 (0.5)	11 (0.7)	6 (1.0)	≥ 0.05
Recurrent disease	829 (4.9)	14 (4.0)	240 (4.6)	306 (5.2)	172 (5.1)	75 (5.0)	22 (3.6)	≥ 0.05
Acute rejection	158 (0.9)	2 (0.6)	57 (1.1)	55 (0.9)	27 (0.8)	10 (0.7)	7 (1.2)	≥ 0.05
Chronic rejection	270 (1.6)	7 (2.0)	104 (2.0)	82 (1.4)	50 (1.5)	17 (1.1)	10 (1.6)	≥ 0.05
Infection	589 (3.5)	11 (3.2)	163 (3.2)	216 (3.7)	119 (3.6)	53 (3.6)	27 (4.5)	≥ 0.05
Recipient death	10172 (60.9)	224 (64.7)	3107 (60.6)	3480 (59.9)	2037 (60.8)	945 (64.2)	379 (62.9)	≥ 0.05
Unknown	3886 (23.2)	73 (21.1)	1217 (23.7)	1380 (23.7)	779 (23.2)	308 (20.9)	129 (21.4)	≥ 0.05

WHO: World Health Organization; BMI: Body mass index.

Table 7 Summary of the primary causes mortality during the index admission for liver transplantation stratified by recipients body mass index n (%)

		WHO recipients' MBI class						Group comparisons	P value
					Obese recipients
Primary cause of perioperative mortality	All recipients (n = 48281)	Underweight (n = 914)	Normal weight (n = 14529)	Overweight (n = 16724)	Class I (n = 9944)	Class II (n = 4438)	Class III (n = 1732)
		(I)	(II)	(III)	(IV)	(V)	(VI)
Infections or multiorgan failure	718 (1.4)	22 (2.4)	202 (1.3)	229 (1.3)	155 (1.5)	67 (1.5)	43 (2.4)		≥ 0.05
Cerebrovascular complication	155 (0.3)	4 (0.4)	47 (0.3)	60 (0.3)	25 (0.2)	14 (0.3)	5 (0.2)		≥ 0.05
Hemmorrhagic	128 (0.2)	3 (0.3)	38 (0.2)	41 (0.2)	32 (0.3)	11 (0.2)	3 (0.1)		≥ 0.05
Single organ failure	102 (0.2)	1 (0.1)	25 (0.1)	35 (0.2)	21 (0.2)	13 (0.2)	7 (0.4)		≥ 0.05
Intraoperative complications	75 (0.1)	2 (0.2)	30 (0.2)	21 (0.1)	12 (0.1)	4 (0.09)	6 (0.3)		≥ 0.05
Cardiovascular or embolic event	53 (0.1)	1 (0.1)	8 (0.05)	16 (0.09)	13 (0.13)	12 (0.2)	3 (0.17)	(II) vs (V)	≤ 0.05
Vascular thrombosis	22 (0.04)	0	5 (0.03)	9 (0.05)	2 (0.02)	4 (0.09)	2 (0.1)		≥ 0.05
Biliary complication	2 (0.004)	0	0	1 (0.005)	1 (0.01)	0	0		≥ 0.05
Primary graft non-function	62 (0.12)	1 (0.1)	11 (0.07)	27 (0.16)	12 (0.12)	5 (0.1)	6 (0.3)		≥ 0.05
Rejection	9 (0.01)	0	3 (0.02)	3 (0.01)	2 (0.02)	1 (0.02)	0		≥ 0.05
Other causes	751 (1.5)	12 (1.3)	203 (1.3)	235 (1.4)	177 (1.7)	91 (2.0)	33 (1.9)		≥ 0.05
Unknown	172 (0.3)	1 (0.1)	57 (0.3)	61 (0.3)	32 (0.3)	13 (0.2)	8 (0.4)		≥ 0.05
Total	2249 (4.6)	47 (5.1)	629 (4.3)	738 (4.4)	484 (4.8)	235 (5.2)	116 (6.6)

WHO: World Health Organization; BMI: Body mass index.

Table 8 Multivariate logistic analysis of in hospital, 90-d and 1-year mortality stratified by recipients’ body mass index at the time of liver transplantation

	Multivariate analysis: In hospital mortality		Multivariate analysis: 90-d mortality		Multivariate analysis: 1-yr mortality
Variable	Odds ratio (95%CI)	P value	Odds ratio (95%CI)	P value	Odds ratio (95%CI)	P value
Recipient BMI
Normal weight	1		1		1
Underweight	1.359 (0.865-2.135)	0.184	1.737 (1.185-2.548)	0.005	1.505 (1.105-2.048)	0.009
Overweight	0.942 (0.798-1.112)	0.481	0.995 (0.856-1.157)	0.950	0.886 (0.792-0.992)	0.036
Obese class I	1.171 (0.974-1.408)	0.094	1.185 (1.000-1.430)	0.050	0.900 (0.792-1.028)	0.120
Obese class II	1.135 (0.889-1.450)	0.309	1.197 (0.959-1.495)	0.112	1.004 (0.846-1.193)	0.960
Obese class III	1.749 (1.276-2.397)	0.001	1.956 (1.473-2.597)	0.000	1.458 (1.154-1.842)	0.002
Donor BMI
Normal weight	1		1		1
Underweight	1.581 (1.214-2.060)	0.001	1.449 (1.131-1.857)	0.003	1.200 (0.978-1.472)	0.080
Overweight	1.025 (0.881-1.194)	0.746	1.008 (0.878-1.158)	0.907	1.025 (0.922-1.140)	0.647
Obese class I	0.983 (0.788-1.226)	0.878	1.016 (0.832-1.239)	0.879	1.061 (0.913-1.233)	0.437
Obese class II	1.217 (0.878-1.686)	0.239	1.189 (0.880-1.606)	0.259	1.223 (0.973-1.536)	0.996
Obese class III	1.013 (0.647-1.585)	0.955	0.952 (0.626-1.448)	0.817	0.999 (0.731-1.365)	0.996
Recipient age
18-45	1		1		1
46-55	1.305 (1.089-1.563)	0.004	1.324 (1.122-1.583)	0.001	1.302 (1.146-1.479)	0.000
56-65	1.563 (1.292-1.891)	0.000	1.719 (1.447-2.041)	0.000	1.650 (1.443-1.888)	0.000
66-75	2.251 (1.737-2.917)	0.000	2.451 (1.941-3.094)	0.000	2.570 (2.146-3.078)	0.000
≥ 76	5.081 (1.410-18.316)	0.013	6.345 (2.060-20.105)	0.001	2.694 (0.871-8.328)	0.344
Donor age
0-17	1		1		1
18-45	1.207 (0.961-1.516)	0.106	1.216 (0.988-1.496)	0.065	1.138 (0.968-1.337)	0.118
46-55	1.492 (1.154-1.929)	0.002	1.411 (1.117-1.784)	0.004	1.464 (1.221-1.755)	0.000
56-65	1.357 (1.027-1.793)	0.032	1.388 (1.079-1.785)	0.011	1.365 (1.123-1.660)	0.002
66-75	1.308 (0.929-1.843)	0.124	1.379 (1.014-1.875)	0.041	1.550 (1.230-1.954)	0.000
≥ 76	0.639 (0.291-1.403)	0.265	0.864 (0.456-1.638)	0.654	1.527 (1.034-2.253)	0.033
Recipient sex (male)	0.909 (0.787-1.050)	0.194	0.966 (0.847-1.102)	0.608	1.051 (0.948-1.164)	0.344
Donor sex (male)	1.017 (0.888-1.164)	0.807	1.009 (0.892-1.142)	0.888	0.993 (0.904-1.092)	0.888
Cold ischemia time (h)	1.033 (1.019-1.047)	0.000	1.021 (1.007-1.035)	0.003	1.024 (1.013-1.035)	0.000
Warm ischemia time (min)	1.008 (1.005-1.011)	0.000	1.007 (1.005-1.010)	0.000	1.006 (1.004-1.008)	0.000
Year of transplantation	0.987 (0.968-1.006)	0.182	0.970 (0.953-0.987)	0.000	1.003 (0.989-1.016)	0.686
Dialysis	2.922 (2.378-3.590)	0.000	2.824 (2.326-3.429)	0.000	2.436 (2.071-2.865)	0.000
Diabetes	1.165 (0.990-1.371)	0.065	1.149 (0.992-1.331)	0.063	1.226 (1.095-1.374)	0.000
COPD	1.276 (0.803-2.027)	0.303	1.155 (0.996-1.341)	0.057	1.233 (0.883-1.720)	0.219
Hypertension	0.957 (0.796-1.151)	0.642	0.959 (0.810-1.135)	0.624	1.027 (0.905-1.166)	0.680
Primary indication for transplant
HCV	1.369 (1.114-1.682)	0.003	1.215 (1.049-1.408)	0.009	0.980 (0.847-1.135)	0.791
Alcohol + HCV	1.307 (0.976-1.752)	0.073	1.038 (0.808-1.332)	0.772	0.961 (0.788-1.173)	0.698
HCV + Other viral hepatitis	1.307 (0.976-1.752)	0.073	0.895 (0.509-1.575)	0.701	0.876 (0.564-1.362)	0.558
Other	0.730 (0.549-0.970)	0.030	0.693 (0.544-0.883)	0.003	0.843 (0.677-1.050)	0.128
Alcohol	1.380 (1.095-1.740)	0.006	1.172 (0.988-1.391)	0.068	1.366 (1.153-1.618)	0.000
HBV	1.230 (0.871-1.737)	0.239	1.263 (0.912-1.747)	0.159	1.326 (1.023-1.719)	0.033
PSC	1.749 (1.229-2.489)	0.002	1.608 (1.190-2.172)	0.002	1.777 (1.377-2.293)	0.000
PBC	1.989 (1.394-2.837)	0.000	1.834 (1.352-2.487)	0.000	1.754 (1.365-2.252)	0.000
NASH	1.564 (0.899-2.722)	0.113	1.043 (0.660-1.649)	0.857	1.298 (0.902-1.869)	0.160
Autoimmune	1.179 (0.825-1.686)	0.365	0.879 (0.648-1.191)	0.405	1.027 (0.794-1.329)	0.840
Acute liver failure	0.839 (0.462-1.522)	0.839	0.797 (0.450-1.410)	0.435	1.183 (0.712-1.964)	0.517
Congenital or metabolic disease	1.139 (0.832-1.522)	0.563	1.094 (0.821-1.458)	0.540	1.162 (0.919-1.469)	0.211

HCV: Hepatitis C virus; HBV: Hepatitis B virus; PSC: Primary sclerosing cholangitis; NASH: Non-alcoholic steatohepatitis; COPD: Chronic obstructive pulmonary disease; PBC: Primary biliary cirrhosis.