Clinical outcomes in overweight heart transplant recipients

Jalowiec, Anne; Grady, Kathleen L.; White‐Williams, Connie

doi:10.1016/j.hrtlng.2016.03.005

Cited by 12 publications

(6 citation statements)

References 42 publications

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“… 83 While some studies have shown improved survival in overweight HT patients, these patients also suffered from more graft rejections, coronary artery vasculopathy and DM. 84 Because HF incidence continues to increase while organs remain in limited supply, optimal strategies for improving outcomes following HT are of utmost importance. Alyaydin et al 85 analyzed 172 HT patients for mean 13.2 years and analyzed their patients as survivors and non-survivors.…”

Section: Heart Transplantmentioning

confidence: 99%

Implications of obesity across the heart failure continuum

Elagizi

Carbone

Lavie

et al. 2020

Progress in Cardiovascular Diseases

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The obesity paradox, which suggests a survival advantage for the obese in heart failure (HF) has sparked debate in the medical community. Studies demonstrate a survival advantage in obese patients with HF, including those with advanced HF requiring continuous inotropic support for palliation or disease modifying therapy with a left ventricular assist device (LVAD) or heart transplantation (HT). Importantly, the obesity paradox is affected by the level of cardiorespiratory fitness (CRF). It is now recommended that HF patients with body mass index ≥35 kg/m 2 achieve at least 5–10% weight loss, in order to improve symptoms and cardiac function, though more robust data are urgently needed. CRF may be the single best predictor of overall health and small improvements in fitness levels may lead to improved outcomes in HF. In addition to implications of obesity in chronic HF, we also discuss management of obese patients with advanced HF and their implications for therapies such as LVAD implantation and HT.

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Section: Heart Transplantmentioning

confidence: 99%

Implications of obesity across the heart failure continuum

Elagizi

Carbone

Lavie

et al. 2020

Progress in Cardiovascular Diseases

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“…A meta-analysis has confirmed the stronger and more consistent association of the somatic (e.g., work difficulty, insomnia, fatigability) than the cognitiveaffective (e.g., sense of failure, guilt, self-dislike) symptom dimension with cardiovascular prognosis (including all-cause mortality), based on 13 prospective longitudinal studies in patients with heart disease (9); however we lack comparable data on HTx samples. (10,12,13). BMI should nevertheless be included as covariate in survival analyses because BMI values in the range indicating overweight and obesity are associated with increased mortality in never-smokers without chronic diseases (14).…”

Section: Introductionmentioning

confidence: 99%

The Predictive Value of Depression in the Years After Heart Transplantation for Mortality During Long-Term Follow-Up

et al. 2019

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Objective: Current understanding of the prognostic impact of depression on mortality after heart transplantation (HTx) is limited. We examined whether depression after HTx is a predictor of mortality during extended follow-up. Subsequently, we explored whether different symptom dimensions of depression could be identified, and whether they were differentially associated with mortality. Methods: Survival analyses were performed in a sample of 141 HTx recipients assessed for depression, measured by self-report of depressive symptoms (Beck Depression Inventoryversion 1A (BDI-1A)), at median 5.0 years after HTx, and followed thereafter for survival status for up to 18.6 years. We used uni-and multivariate Cox proportional hazard models to examine the association of clinically significant depression (BDI-1A total score ≥10), as well as the cognitive-affective and the somatic subscales of the BDI-1A (resulting from principal component analysis) with mortality. In the multivariate analyses, we adjusted for relevant sociodemographic and clinical variables. Results: Clinically significant depression was a significant predictor of mortality (hazard ratio (HR): 2.088; 95% confidence interval (95% CI): 1.366-3.192; p=.001). Clinically significant depression also was an independent predictor of mortality in the multivariate analysis (HR: 1.982; 95% CI: 1.220-3.217; p=.006). The somatic subscale, but not the cognitive-affective subscale, was significantly associated with increased mortality in univariate analyses, while neither of the two subscales was an independent predictor of mortality in the multivariate analysis. Psychosom Med Depression and mortality after HTx 24.01.19 2 Conclusions: Depression measured by self-report after HTx is associated with increased mortality during extended follow-up. Clinical utility and predictive validity of specific depression components require further study.

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“…51 As excessive weight gain and obesity after transplantation are associated with high risk of diabetes, graft loss, and mortality. 4,8 Further, overweight and obesity and related comorbidity ( e.g. , CAV) are important determinants of transplant recipients’ quality of life.…”

Section: Discussionmentioning

confidence: 99%

“…8 The first 12 months following transplantation is critical as excessive weight gain during this period influences transplant outcomes such as graft rejection. 8,9 However, the magnitude of reported weight increase appears to vary substantially, and the rapidity of weight gain is unclear.…”

mentioning

confidence: 99%

Weight Gain After Heart Transplantation in Adults: Systematic Review and Meta-Analysis

Miura

Sivapalan

et al. 2021

ASAIO Journal

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Gain in weight is common after heart transplantation but the magnitude of usual weight gain and whether this varies by country is unknown. We systematically reviewed all relevant studies to quantify weight change among heart transplant recipients (HTRs) in the years after transplantation and assess variation with geographic location. We searched PubMed, Cumulative Index to Nursing and Allied Health Literature, and Excerpta Medica Database databases to September 2020. Eligible studies reported adult HTRs’ mean/median weight and/or body mass index (BMI) up to time of transplantation (baseline) and posttransplantation in any language. Weighted mean differences (WMDs) (95% confidence intervals [CIs]) of weight/BMI from baseline to posttransplantation were estimated using a random-effects model. Ten studies met the inclusion criteria. Pooled analysis showed weight gain of 7.1 kg (95% CI, 4.4–9.8 kg) in HTRs 12 months posttransplant, with corresponding BMI increase of 1.69 kg/m2 (95% CI, 0.83–2.55 kg/m2). Greatest weight gain at 12 months posttransplant occurred in US HTRs (WMD weight 10.42 kg, BMI 3.25 kg/m2) and least, in European HTRs (WMD weight 3.10 kg, BMI 0.78 kg/m2). In conclusion, HTRs gain substantial weight in the years after transplantation, but varying widely by geographic location.

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Clinical outcomes in overweight heart transplant recipients

Cited by 12 publications

References 42 publications

Implications of obesity across the heart failure continuum

Implications of obesity across the heart failure continuum

The Predictive Value of Depression in the Years After Heart Transplantation for Mortality During Long-Term Follow-Up

Weight Gain After Heart Transplantation in Adults: Systematic Review and Meta-Analysis

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