Weight gain post–heart transplantation is associated with an increased risk for allograft vasculopathy and rejection

Abstract

OBJECTIVE Obesity and overweight are associated with an increased risk for cardiovascular disease. Since fat mass (FM) and fat‐free mass (FFM) both contribute to total body weight (TBW), we characterized the post–heart transplantation (HT) change in TBW and its implications for outcomes. METHODS Post‐HT changes in TBW, FM, and FFM were reviewed for 211 HT patients assessed during 1997–2017. Endpoints included cardiac allograft vasculopathy (CAV) and rejection. RESULTS Median TBW increased by 7.3% at 1 year, with a significant rise in the obese category (28% vs. 13%, p < 0.001) and with FM versus FFM making the main contribution (23% vs. 3%, p < 0.001). When patients were divided according to median TBW change (“high” vs. “low”), Kaplan–Meier analysis showed that 10‐year freedom from CAV (log‐rank p < 0.005) and rejection (log‐rank p < 0.01) was significantly higher for the “low” TBW change group. Consistently, multivariable analyses showed that the “high” group was independently associated with significant 3.5‐fold and 4.2‐fold increased risks for CAV (95% CI 1.4–8.7, p = 0.01) and rejection (95% CI 1.2–15.4, p = 0.03), respectively. CONCLUSIONS Weight gain, contributed mostly by FM, is independently associated with an increased risk for CAV and rejection. Follow‐up emphasis should be placed on weight gain and preventative measures.

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

“…A study of 59 Norwegian HTRs observed a relatively stable total lean mass with a small total fat mass increase (26%-28%), 19 consistent with the majority of HTRs living a sedentary lifestyle, 19,20 and weight gain more likely due to increased fat. 19,[21][22][23] Our findings regarding serum total cholesterol are consistent with previous observations that the highest increases also occur in the first 12 months, 12,13 though others have observed a further increase in cholesterol levels after 12 months, and a Brazilian study of 82…”

“…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. A study of 59 Norwegian HTRs observed a relatively stable total lean mass with a small total fat mass increase (26%–28%), 19 consistent with the majority of HTRs living a sedentary lifestyle, 19,20 and weight gain more likely due to increased fat 19,21‐23 …”

“…Different types of statins may have different potencies, but we assumed that types of statins did not change during follow‐up. Also, given that CAV and graft failure progressively become leading causes of mortality with increasing time since transplantion, 2 a further study limitation was our lack of longer‐term clinical data among HTRs; ideally, we would have related weight change to outcomes, particularly CAV, at 5–10 years post‐transplant 23 . Finally, since this is a single center study and the representativeness is unknown, findings may not be generalizable.…”

“…A study of 59 Norwegian HTRs observed a relatively stable total lean mass with a small total fat mass increase (26%–28%), 19 consistent with the majority of HTRs living a sedentary lifestyle, 19 , 20 and weight gain more likely due to increased fat. 19 , 21 , 22 , 23 …”

Early Postoperative Cardiac Complications Following Heart Transplantation

“…In addition, another recent study showed that the weight gain in recipients after heart transplantation could increase the risk for allograft vasculopathy and rejection, suggesting the impact of obesity on outcomes of heart transplantation [109].…”