Impact of Obesity on Heart Transplantation Outcomes

Abstract

Background Patients with obesity and advanced heart failure face unique challenges on the path to heart transplantation. There are limited data on waitlist and transplantation outcomes in this population. We aimed to evaluate the impact of obesity on heart transplantation outcomes, and to investigate the effects of the new organ procurement and transplantation network allocation system in this population. Methods and Results This cohort study of adult patients listed for heart transplant used the United Network for Organ Sharing database from January 2006 to June 2020. Patients were stratified by body mass index (BMI) (18.5–24.9, 25–29.9, 30–34.9, 35–39.9, and 40–55 kg/m 2 ). Recipient characteristics and donor characteristics were analyzed. Outcomes analyzed included transplantation, waitlist death, and posttransplant death. BMI 18.5 to 24.9 kg/m 2 was used as the reference compared with progressive BMI categories. There were 46 645 patients listed for transplantation. Patients in higher BMI categories were less likely to be transplanted. The lowest likelihood of transplantation was in the highest BMI category, 40 to 55 kg/m 2 (hazard ratio [HR], 0.19 [0.05–0.76]; P =0.02). Patients within the 2 highest BMI categories had higher risk of posttransplantation death (HR, 1.29; P <0.001 and HR, 1.65; P <0.001, respectively). Left ventricular assist devices among patients in obese BMI categories decreased after the allocation system change ( P <0.001, all). After the change, patients with obesity were more likely to undergo transplantation (BMI 30–35 kg/m 2 : HR, 1.31 [1.18–1.46], P <0.001; BMI 35–55 kg/m 2 : HR, 1.29 [1.06–1.58]; P =0.01). Conclusions There was an inverse relationship between BMI and likelihood of heart transplantation. Higher BMI was associated with increased risk of posttransplant mortality. Patients with obesity were more likely to undergo transplantation under the revised allocation system.

Validation of days alive and out of hospital as a new patient-centered outcome to quantify life impact after heart transplantation

“…Another data registry study including 38.498 patients showed that underweight and obese patients had significantly higher risk for mortality 18 . In this context another recent registry study confirmed the results for obese patients 19 . However, previous evidence on influence of BMI on 1-year mortality is contradicting as other studies showed similar 1-year survival of obese patients compared to normal BMI patients 13 , 20 , 21 .…”

Machine learning and artificial intelligence in cardiac transplantation: A systematic review

“…11,14,15,17,18 This is consistent with previously published studies. 29 Two biomarkers found to have a major influence on graft failure were pre-transplant creatinine and bilirubin. 12,14,15,17,18 Previous studies have highlighted this relationship as creatinine and bilirubin are useful indicators to assess overall kidney and liver health, both of which are crucial in cardiovascular health in the post-transplant patient.…”

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

“…Orthotopic heart transplant (OHT) is considered the reference standard treatment for patients with end-stage heart failure. With the obesity epidemic, there has been a consistent increase in body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) among transplant recipients over the last few decades . Patients with obesity on the transplant list face longer wait times, with each increase in BMI associated with a 4% lower likelihood of receiving a transplant .…”

“…Patients with obesity on the transplant list face longer wait times, with each increase in BMI associated with a 4% lower likelihood of receiving a transplant . Similarly, the BMIs of the available donors have also increased by 1 BMI point from 2006 to 2020 …”