Outcomes of Heart Transplant Recipients with Class II Obesity: A United Network for Organ Sharing Database Analysis

Yuangao Liu, Fernando A. Padilla, Edward A. Graviss, Duc T. Nguyen, Harveen K. Lamba, Swami Gnanashanmugam, Subhasis Chatterjee, Erik Suarez, Arvind Bhimaraj

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)69-78
Number of pages10
JournalJournal of Surgical Research
Volume272
DOIs
StatePublished - Apr 2022

Keywords

  • Body mass index
  • Cardiac transplantation
  • Obesity

ASJC Scopus subject areas

  • Surgery

Fingerprint

Dive into the research topics of 'Outcomes of Heart Transplant Recipients with Class II Obesity: A United Network for Organ Sharing Database Analysis'. Together they form a unique fingerprint.

Cite this