Highlights
- •The 2016 ISHLT listing criteria for heart transplantation recommended that recipients have a BMI <35 kg/ m², putting obese individuals who need cardiac transplantation at a disadvantage.
- •Recipients with a BMI of 35 to 39.9 kg/ m² have better outcomes than do those with a BMI ≥40 kg/m2 and should be considered as a distinct group.
- •Selected individuals with a BMI of 35 to 39.9 kg/m2 should be considered as candidates for heart transplantation.
- •Improved quality of life and survival from a heart transplantation outweigh the risks associated with a BMI of 35 to 39.9 kg/m2.
ABSTRACT
Background
In the 2016 ISHLT listing criteria guidelines for heart transplantation, recipients
were recommended to have a body mass index (BMI) <35 kg/m². However, outcomes data
for subgroups of transplant recipients with a BMI >35 kg/m² are limited. We examined
the outcomes of heart transplant recipients who had a BMI of 35 to 39.9 kg/m² or ≥40
kg/m² and compared their outcomes with recipients who had a BMI <35 kg/m2.
Methods
Using data from the United Network for Organ Sharing database, we performed a retrospective
cohort analysis of 23,009 adults who underwent cardiac transplantation between 2009
and 2018. Transplant recipients were stratified by BMI categories (<35 kg/m², 35-39.9
kg/m², and ≥40 kg/m²). Patient survival was depicted by Kaplan-Meier curves. Cox proportional-hazards
modeling was used to determine the prognostic factors associated with mortality within
90 days, 1 year, and 5 years after transplantation.
Results
Survival at 90 days, 1 year, and 5 years after transplantation was better in recipients
who had a BMI <35 kg/m² than in those who had a BMI of 35 to 39.9 kg/m² (P values ranged from 0.01 to < 0.001) or ≥40 kg/m² (P < 0.001). Additionally, survival at 90 days (P < 0.001) and 1 year (P = 0.002) was significantly better in recipients who had a BMI of 35 to 39.9 kg/m²
than in those who had a BMI ≥40 kg/m². In multivariate analysis, a BMI of 35 to 39.9
was significantly associated with increased 90-day mortality (HR = 1.53; 95% CI 1.12,
2.08; P = 0.01) but not increased 1-year (HR = 1.28; 95% CI 0.99, 1.66; P = 0.06) or 5-year mortality (HR = 1.11; 95% CI 0.91, 1.36; P = 0.29).
Conclusions
Although heart transplant recipients with class II obesity (BMI 35-39.9 kg/m²) may
have suboptimal survival compared with those who have a BMI <35 kg/m², these patients
have better outcomes than do those with class III obesity (BMI ≥40 kg/m²). Thus, contrary
to current guidelines, selected patients with class II obesity should be considered
for transplantation.
Keywords
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References
- The varying effects of obesity and morbid obesity on outcomes following cardiac transplantation.Int J Obes (Lond). 2016; 40: 721-724https://doi.org/10.1038/ijo.2016.20
- Recipient body mass index and age interact to impact survival after heart transplantation.Clin Transplant. 2014; 28: 1279-1286https://doi.org/10.1111/ctr.12460
- Impact of pretransplant recipient body mass index on post heart transplant mortality: A systematic review and meta-analysis.Clin Transplant. 2018; 32: e13348https://doi.org/10.1111/ctr.13348
- The 2016 International Society for Heart Lung Transplantation listing criteria for heart transplantation: A 10-year update.J Heart Lung Transplant. 2016; 35: 1-23https://doi.org/10.1016/j.healun.2015.10.023
- Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: executive summary. Expert Panel on the Identification, Evaluation, and Treatment of Overweight in Adults.Am J Clin Nutr. 1998; 68: 899-917https://doi.org/10.1093/ajcn/68.4.899
- The effect of body mass index on survival following heart transplantation: do outcomes support consensus guidelines?.Ann Surg. 2010; 251: 144-152https://doi.org/10.1097/SLA.0b013e3181b5db3c
- Donor age still matters in liver transplant: Results from the United Network for Organ Sharing-scientific registry of transplant recipients database.Exp Clin Transplant. 2017; 15: 536-541https://doi.org/10.6002/ect.2016.0011
World Health Organization. Body mass index - BMI. Available at: https://www.euro.who.int/en/health-topics/disease-prevention/nutrition/a-healthy-lifestyle/body-mass-index-bmi. Accessed September 12.
Stata Base Reference Manual, Release 16. Stata Press. Available at: https://www.stata.com/manuals/r.pdf. Accessed September 12.
Hastie T, Tibshirani R, Wainwright M. Statistical learning with sparsity: The lasso and generalizations. Available at: https://web.stanford.edu/~hastie/StatLearnSparsity_files/SLS_corrected_1.4.16.pdf. Accessed September 12.
- The impact of obesity on patients bridged to transplantation with continuous-flow left ventricular assist devices.JACC Heart Fail. 2016; 4: 761-768https://doi.org/10.1016/j.jchf.2016.05.010
- The Society of Thoracic Surgeons Intermacs 2019 Annual Report: The changing landscape of devices and indications.Ann Thorac Surg. 2020; 109: 649-660https://doi.org/10.1016/j.athoracsur.2019.12.005
- Obesity and its comorbid conditions.Clin Cornerstone. 1999; 2: 17-31https://doi.org/10.1016/s1098-3597(99)90002-9
- Evidence for obesity paradox in patients with acute coronary syndromes: a report from the Swedish Coronary Angiography and Angioplasty Registry.Eur Heart J. 2012; 34: 345-353https://doi.org/10.1093/eurheartj/ehs217
- Donor and recipient age matching in heart transplantation: analysis of the UNOS Registry.Transpl Int. 2019; 32: 1194-1202https://doi.org/10.1111/tri.13481
- Body mass index and mortality in heart failure: A meta-analysis.Am Heart J. 2008; 156: 13-22https://doi.org/10.1016/j.ahj.2008.02.014
- Body mass index and mortality among adults undergoing cardiac surgery.Circulation. 2017; 135: 850-863https://doi.org/10.1161/CIRCULATIONAHA.116.022840
- Is the obesity paradox in cardiac surgery really a myth? Effect of body mass index on early and late clinical outcomes.J Cardiothorac Vasc Anesth. 2021; 35: 492-498https://doi.org/10.1053/j.jvca.2020.03.051
- Clearing up the obesity paradox in cardiac surgery.J Cardiothorac Vasc Anesth. 2021; 35: 959-960https://doi.org/10.1053/j.jvca.2020.06.057
- The effect of pre-heart transplant body mass index on posttransplant outcomes: An analysis of the ISHLT Registry Data.Clin Transplant. 2019; 33: e13621https://doi.org/10.1111/ctr.13621
- Impact of body mass index on outcomes of 48281 patients undergoing first time cadaveric liver transplantation.World J Transplant. 2016; 6: 356-369https://doi.org/10.5500/wjt.v6.i2.356
- Post-transplantation body mass index in heart transplant recipients: determinants and consequences.Transplant Proc. 2014; 46: 2844-2847https://doi.org/10.1016/j.transproceed.2014.09.025
World Health Organization. Obesity: Preventing and managing the gloval epidemic. In 2000. Pp. 252.
Article info
Publication history
Published online: December 19, 2021
Accepted:
November 16,
2021
Received in revised form:
September 23,
2021
Received:
June 7,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
