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

Abstract

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.

Bioimpedance Spectroscopy in Heart Transplantation: Posttransplant Changes in Body Composition and Effects in Outcomes

“…A recent meta-analysis reported that patients gained an average of 7 kg (increase in BMI by 1.7 kg/m 2 ) in the first year posttransplant. 20 To our knowledge, no data exist about specific body composition indices and In this 1-y study, mean fat mass increased posttransplantation; conversely, mean fat-free mass fell and reached a nadir at 3 mo. In prior studies following cardiac surgery, sarcopenic obesity (defined as low fat-free mass with high-fat mass) was linked with a significantly increased risk of postoperative infections.…”

“…A recent meta-analysis reported that patients gained an average of 7 kg (increase in BMI by 1.7 kg/m 2 ) in the first year posttransplant. 20 To our knowledge, no data exist about specific body composition indices and functional capacity tests and their impact on the clinical course of patients following heart transplantation.…”

Long‐term changes in body weight and serum cholesterol in heart transplant recipients

“…7 For example, weight gain in North American HTRs was about 10 kg (BMI +3.25 kg/m 2 ) compared with about 6 kg in Australia (based on 22 HTRs) 11 and about 3 kg (BMI + .78 kg/m 2 ) in European countries. 7 Our contemporary study HTRs had heavier mean BMI throughout than Australian HTRs two decades previously, but weight increase was smaller. 13 Weight gain in HTRs may be due partly to increased lean mass due to increased physical activity after transplantation; we could not distinguish an increase in fat from lean mass.…”

Association of diet quality and weight increase in adult heart transplant recipients

“…25 We found the diet quality of study HTRs to be universally low, especially as a result of low fruit and vegetable intakes (median serves of vegetables day -1 and 0.5 serves of fruit day -1 ). Because the prevalence of cardiovascular disease risk factors is high in HTRs 2 including in Queensland, 3 encouraging these patients to follow the DASH dietary pattern and focus on plant-based foods would likely improve their cardiometabolic status in the long-term.…”

“…2 Similarly, post-transplant weight gain is common, with an approximate 7 kg weight gain reported on average in the first year after transplantation. 3 Excessive weight gain and other metabolic disorders can lead to the development of cardiac allograft vasculopathy, the main complication that limits the survival of HTRs. 4 Among the general population, a fundamental approach to reducing risk of cardiometabolic disease is following a healthy diet.…”