The varying effects of obesity and morbid obesity on outcomes following cardiac transplantation

Abstract

The purpose of this study was to compare the outcomes of patients undergoing cardiac transplantation stratified by body mass index (BMI, kg m(-)(2)). The Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease registry captured 220 cardiac transplantations in Alberta, Canada from January 2004 to April 2013. All recipients were stratified by BMI into five groups (BMI: <20, 20-24.9, 25-29.9, 30-<34.9 and ⩾35). Patient characteristics were analyzed by analysis of variance and χ(2) analyses. Kaplan-Meier was used to examine survival differences. Preoperative characteristics demonstrated significant increases in metabolic syndrome, prior myocardial infarction and prior coronary artery bypass graft in patients with morbid obesity. Intra-operatively, there was an increase in cardiopulmonary bypass time in patients with morbid obesity (P<0.01). Postoperative analysis revealed increased rates of early complications (<30 days), associated with a BMI >35. Long-term survival was also significantly decreased in patients with morbid obesity. Of interest, obesity (BMI, 30-34.9) was not associated with decreased survival. These findings suggest that, post-cardiac transplantation, patients who have a BMI ⩾35 have lower long-term survival compared with all other BMI groups. However, patients with BMI 30-34.9 did not have significantly worse outcomes and should not be excluded for heart transplantation based on BMI.

The international prevalence and variability of nonadherence to the nonpharmacologic treatment regimen after heart transplantation: Findings from the cross‐sectional BRIGHT study

“…Yet, the question of whether overweight and obesity negatively impact post‐HTx clinical outcomes also remains controversial. Most studies focusing on body mass index (BMI) at time of transplant have found an elevated risk for graft loss and mortality in HTx recipients with morbid obesity only (BMI > 35), but not in groups having a low BMI at transplantation . Still, many patients gain weight post‐HTx: one prospective registry study reporting overweight and obesity in, respectively, 37% and 13.6% of patients at 3 years after HTx, which might ultimately elevate the risk for chronic disease.…”

Impact of pretransplant recipient body mass index on post heart transplant mortality: A systematic review and meta‐analysis

“…Five studies reporting on 47 528 recipients transplanted between 1986 and 2014 met our selection criteria [8][9][10][11][12] (Figure 1). …”

Use of an intra-aortic balloon pump during laparoscopic sleeve gastrectomy

“…Heart transplant is the primary treatment for end-stage HF; however, morbid obesity is a relative contraindication to transplantation [8] . A BMI ≥ 35 kg/m 2 is associated with early complications and decreased long-term survival after heart transplant, compared to class I obesity [2] . Weight loss improves cardiovascular function through increased left ventricular diastolic and systolic function, reduction of myocardial oxygen consumption, and reversal of impaired aortic distensibility [4] .…”

“…Heart transplantation is the standard management for advanced HF. However, a body mass index (BMI) ≥ 35 kg/m 2 is associated with increased early complications, decreased longterm survival, and lower likelihood of receiving an organ [2,3] . Weight loss results in decreased vascular stiffness and reduction in ventricular hypertrophy [4] .…”