Effect of obesity on outcome after cardiac transplantation

Abstract

OBESITY is a well-described and significant risk factor for postoperative medical complications in surgery. High incidences of wound infection and dehiscence, thrombophlebitis, and pulmonary insufficiency have been reported. Obese surgical patients have abnormalities in cardiac, pulmonary, endocrine, and gastrointestinal function, as well as abnormalities in pharmacokinetics and pharmacodynamics. Obesity is also associated with the development of some of the most prevalent diseases of modern society: Cardiovascular as well as cerebrovascular disease, diabetes, and hypertension. More postoperative complications and the same comorbidities might also be expected in obese transplant recipients, which could lead to increased postoperative morbidity and mortality. In fact, reports on solid organ transplantation, including kidney, liver, and pancreas indicated in agreement a poorer outcome in obese organ recipients in terms of graft and patient survival. There is little information, however, on the impact of obesity on outcome after cardiac transplantation. Organ donor shortages mandate careful assessment of preoperative risk for heart transplantation to enable appropriate patient selection for this procedure. Therefore the purpose of the present study was to determine the impact of preoperative overweight and obesity as defined by body mass index (BMI 5 kg/m) on outcome after heart transplantation with regard to patient survival, surgical complications, incidence of infection, acute rejection and development of transplant coronary artery disease.