Alnagar A, Khan MU, Ahmad MS, Mersal M, Ayyad M, Hassan R, Noormohamed MS. Glucagon-like peptide-1 agonists usage to widen the living donor pool for liver transplantation: A novel metabolic strategy. World J Transplant 2026; 16(2): 118702 [DOI: 10.5500/wjt.v16.i2.118702]
Corresponding Author of This Article
Amr Alnagar, PhD, Ms, MRCS, Department of General Surgery, University Hospitals of Birmingham, 6 Chamberlain Road, Birmingham B9 5SS, United Kingdom. amr.alnagar@nhs.net
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Transplantation
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review-article
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Alnagar A, Khan MU, Ahmad MS, Mersal M, Ayyad M, Hassan R, Noormohamed MS. Glucagon-like peptide-1 agonists usage to widen the living donor pool for liver transplantation: A novel metabolic strategy. World J Transplant 2026; 16(2): 118702 [DOI: 10.5500/wjt.v16.i2.118702]
World J Transplant. Jun 18, 2026; 16(2): 118702 Published online Jun 18, 2026. doi: 10.5500/wjt.v16.i2.118702
Glucagon-like peptide-1 agonists usage to widen the living donor pool for liver transplantation: A novel metabolic strategy
Amr Alnagar, Muhammad U Khan, Muhammad S Ahmad, Mahmoud Mersal, Mohamed Ayyad, Rana Hassan, Mohamed Saleem Noormohamed
Amr Alnagar, Department of General Surgery, University Hospitals of Birmingham, Birmingham B9 5SS, United Kingdom
Muhammad U Khan, Mahmoud Mersal, Mohamed Ayyad, Department of Upper GIT Surgery, University Hospitals of Birmingham, Birmingham B9 5SS, United Kingdom
Muhammad S Ahmad, Department of General Surgery, The Dudley Group NHS Foundation Trust, Dudley DY1 2HQ, United Kingdom
Rana Hassan, Department of Gyneacology, Ras Elteen Hospital, Alexandria 21532, Egypt
Mohamed Saleem Noormohamed, Department of Upper GIT Surgery, Worcestershire Acute Hospitals, Worcester WR5 1DD, United Kingdom
Author contributions: Alnagar A designed the study, Khan MU, Ahmad MS, Mersal M, Ayyad M, and Hassan R conducted the literature review and wrote the manuscript draft; Noormohamed MS performed the critical revision and final drafting of the manuscript; and all authors thoroughly reviewed and endorsed the final manuscript.
AI contribution statement: ChatGPT was used for language polishing and editing, not for scientific content, image generation or study design.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Amr Alnagar, PhD, Ms, MRCS, Department of General Surgery, University Hospitals of Birmingham, 6 Chamberlain Road, Birmingham B9 5SS, United Kingdom. amr.alnagar@nhs.net
Received: January 9, 2026 Revised: January 27, 2026 Accepted: March 2, 2026 Published online: June 18, 2026 Processing time: 140 Days and 21.2 Hours
Abstract
Glucagon-like peptide-1 (GLP-1)/glucose-dependent insulinotropic polypeptide receptor agonists’ use as a weight loss tool is gradually expanding. They can be used as bridging therapies to reduce weight in potential living donors for liver transplantation and improve graft quality. A living donor with high body mass index is likely to be declined in most living donor programs due to concerns about donor safety and graft function. Reducing weight before surgical procedures can improve outcomes and lower the incidence of morbidity and mortality. Growing clinical evidence supports the advantage of GLP-1 receptor agonists as well as GLP-1/glucose-dependent insulinotropic polypeptide receptor agonists as bridging therapies to minimize perioperative complications. However, these agents should be used with caution due to concerns about side effects, particularly delayed gastric emptying and the risk of aspiration. This article summarizes the available evidence about the promising use of new weight-reducing agents to expand graft pool by including higher body mass index donors after weight optimization.
Core Tip: The use of glucagon-like peptide-1/glucose-dependent insulinotropic polypeptide receptor agonists for weight loss is expanding, particularly as bridging therapies for living donors in liver transplantation. High body mass index donors are often declined due to safety concerns, but weight reduction can improve surgical outcomes and reduce morbidity and mortality. There is growing clinical evidence supporting these agents to minimize perioperative complications. However, they should be used cautiously due to potential side effects like delayed gastric emptying and aspiration risks.
