Center-Level Variations in Maximum Recipient Body Mass Index in Heart Transplantation

Fisher, Bryant; Huckaby, Lauren V.; Sultan, Ibrahim; Hickey, Gavin; Kilic, Arman

doi:10.1016/j.amjcard.2020.12.084

Cited by 2 publications

(5 citation statements)

References 16 publications

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“…Approximately 92% of recipients per transplant center have a body mass index (BMI) <35 kg/m 2 [24], with higher recipient BMI being associated with worse shortand long-term survival after HTx [24][25][26][27][28][29]. Recipients with BMI ≥30 kg/m 2 , under-sizing donor hearts to a predicted heart mass ≤20% does not affect short-and long-term survival after HTx.…”

Section: Recipient Risk Factorsmentioning

confidence: 99%

“…The num-ber of treated rejection episodes within 1-year after HTx has been decreasing over time from nearly 25% in 2004-2006 to 12.6% in 2010-2016 [3]. Risk factors associated with developing rejection include female donor gender, recipient elevated BMI, and recurrent ACR grade 1R [24,36,116,117]. Factors not associated with increased rejection episodes include donor CPR status or history of cocaine use, and recipient history of prior sternotomy or prior MCS use (durable or temporary) [9,40,43,54].…”

Section: Rejection Of Allograftmentioning

confidence: 99%

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Current status and outcomes in heart transplantation: a narrative review

Awad¹,

Shah²,

Griffith³

2022

Rev. Cardiovasc. Med.

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The first human heart transplantation was performed by Christian Barnard in 1967. While the technical aspect had been worked out, allograft rejection was a major limitation in the early days of heart transplant. The discovery of cyclosporine revolutionized the field and led to the modern era of transplant. Heart transplantation now offers the best survival benefit for patients with end-stage heart failure with a median survival over 12 years. However, there are still limitations including the impact of limited availability of graft, graft dysfunction, and rejection, and long-term non-cardiac complications. This review serves as an update on the short-and long-term outcomes following heart transplantation focusing on the new donor allocation system, efforts to expand the donor pool, primary graft dysfunction, acute cellular and antibody-mediated rejection, cardiac allograft vasculopathy, and post-transplant malignancy and renal dysfunction.

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Section: Recipient Risk Factorsmentioning

confidence: 99%

Section: Rejection Of Allograftmentioning

confidence: 99%

Current status and outcomes in heart transplantation: a narrative review

Awad¹,

Shah²,

Griffith³

2022

Rev. Cardiovasc. Med.

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“…In 2006, the International Society for Heart and Lung Transplantation (ISHLT) recommended that patients with a BMI of 30 or higher should lose weight before listing for heart transplant; however, the society subsequently increased their BMI threshold to 35 or higher in 2016 . A recent study found recipients with BMIs between 35 and 38 may be acceptable candidates depending on individual factors and each transplant center's expertise, volume, and preference …”

Section: Introductionmentioning

confidence: 99%

“…7 A recent study found recipients with BMIs between 35 and 38 may be acceptable candidates depending on individual factors and each transplant center's expertise, volume, and preference. 8 There have been continued efforts to expand the donor pool to alleviate the long waiting time, including offering hearts from those who died from drug overdose and are hepatitis C virus positive and donation after circulatory death donors. 5 There is no strict cutoff for donor weight requirements, as it depends on the donor-to-recipient size matching.…”

Section: Introductionmentioning

confidence: 99%

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Association of Size Matching Using Predicted Heart Mass With Mortality in Heart Transplant Recipients With Obesity or High Pulmonary Vascular Resistance

et al. 2023

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ImportancePretransplant obesity and higher pulmonary vascular resistance (PVR) are risk factors for death after heart transplant. However, it remains unclear whether appropriate donor-to-recipient size matching using predicted heart mass (PHM) is associated with lower risk.ObjectiveTo investigate the association of size matching using PHM with risk of death posttransplant among patients with obesity and/or higher PVR.Design, Setting, and ParticipantsAll adult patients (&gt;18 years) who underwent heart transplant between 2003 and 2022 with available information using the United Network for Organ Sharing cohort database. Multivariable Cox models and multivariable-adjusted spline curves were used to examine the risk of death posttransplant with PHM matching. Data were analyzed from October 2022 to March 2023.ExposureRecipient’s body mass index (BMI) in categories (&lt;18.0 [underweight], 18.1-24.9 [normal weight, reference], 25.0-29.9 [overweight], 30.0-34.9 [obese 1], 35-39.9 [obese 2], and ≥40.0 [obese 3]) and recipient’s pretransplant PVR in categories of less than 4 (29 061 participants), 4 to 6 (2842 participants), and more than 6 Wood units (968 participants); and less than 3 (24 950 participants), 3 to 5 (6115 participants), and 5 or more (1806 participants) Wood units.Main OutcomeAll-cause death posttransplant on follow-up.ResultsThe mean (SD) age of the cohort of 37 712 was 52.8 (12.8) years, 27 976 (74%) were male, 25 342 were non-Hispanic White (68.0%), 7664 were Black (20.4%), and 3139 were Hispanic or Latino (8.5%). A total of 12 413 recipients (32.9%) had a normal BMI, 13 849 (36.7%) had overweight, and 10 814 (28.7%) had obesity. On follow-up (median [IQR] 5.05 [0-19.4] years), 12 785 recipients (3046 female) died. For patients with normal weight, overweight, or obese 2, receiving a PHM-undermatched heart was associated with an increased risk of death (normal weight hazard ratio [HR], 1.20; 95% CI, 1.07-1.34; overweight HR, 1.12; 95% CI, 1.02-1.23; and obese 2 HR, 1.07; 95% CI, 1.01-1.14). Moreover, patients with higher pretransplant PVR who received an undermatched heart had a higher risk of death posttransplant in multivariable-adjusted spline curves in graded fashion until appropriately matched. In contrast, risk of death among patients receiving a PHM-overmatched heart did not differ from the appropriately matched group, including in recipients with an elevated pretransplant PVR.Conclusion and RelevanceIn this cohort study, undermatching donor-to-recipient size according to PHM was associated with higher posttransplant mortality, specifically in patients with normal weight, overweight, or class II obesity and in patients with elevated pretransplant PVR. Overmatching donor-to-recipient size was not associated with posttransplant survival.

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Center-Level Variations in Maximum Recipient Body Mass Index in Heart Transplantation

Cited by 2 publications

References 16 publications

Current status and outcomes in heart transplantation: a narrative review

Current status and outcomes in heart transplantation: a narrative review

Association of Size Matching Using Predicted Heart Mass With Mortality in Heart Transplant Recipients With Obesity or High Pulmonary Vascular Resistance

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