Recipient Morbid Obesity Worsens Post Heart Transplantation Survival

Abstract

PurposeMorbid obesity (body mass index (BMI) ≥ 35kg/m2) is a relative contraindication for a heart transplant (HT). However, the clinical outcome of these HT recipients is not well established. This study examined the clinical outcome of morbidly obese patients who underwent HT in The United States.MethodsWe included adult patients who underwent HT between 2000 and 2018 in the Scientific Registry of Transplant Recipients with available BMI information. We compared 30-day, 1-, 5-, and 10-year survival of those with a BMI≥ 35 kg/m2 and BMI = 18.5-34.99 kg/m2. Cox proportional hazards regression models then determined the influence of BMI category on survival adjusting for known recipient and donor risk factors, including Index for Mortality Prediction After Cardiac Transplantation (IMPACT) score and predicted heart mass ratio.Results36,115 adult HT recipients were included: 2638 (7.3%) morbidly obese. The median (inter-quartile range) age was 55 (46, 62) years, 24.7% were female, and follow-up was 4.1 (1.1, 8.3) years. Morbidly obese patients had more hypertension (p<0.0001), diabetes (p<0.0001), and VAD use (p<0.0001). Survival among morbidly obese compared to other group was lower at 30-day, 1-, 5- , and 10-years. After adjustment for known risks, morbid obesity was associated with higher post-transplant 30-day (HR 1.64, 95% CI 1.37-1.97), 1-year (HR 1.50, 1.33-1.69), 5-year (HR 1.36, 1.24-1.49), and 10-year mortality risk (HR 1.28, 1.19-1.39).ConclusionSurvival following HT was significantly lower in recipients with morbid obesity. The risk associated with BMI≥ 35kg/m2 should be considered at the time of transplant assessment. Morbid obesity (body mass index (BMI) ≥ 35kg/m2) is a relative contraindication for a heart transplant (HT). However, the clinical outcome of these HT recipients is not well established. This study examined the clinical outcome of morbidly obese patients who underwent HT in The United States. We included adult patients who underwent HT between 2000 and 2018 in the Scientific Registry of Transplant Recipients with available BMI information. We compared 30-day, 1-, 5-, and 10-year survival of those with a BMI≥ 35 kg/m2 and BMI = 18.5-34.99 kg/m2. Cox proportional hazards regression models then determined the influence of BMI category on survival adjusting for known recipient and donor risk factors, including Index for Mortality Prediction After Cardiac Transplantation (IMPACT) score and predicted heart mass ratio. 36,115 adult HT recipients were included: 2638 (7.3%) morbidly obese. The median (inter-quartile range) age was 55 (46, 62) years, 24.7% were female, and follow-up was 4.1 (1.1, 8.3) years. Morbidly obese patients had more hypertension (p<0.0001), diabetes (p<0.0001), and VAD use (p<0.0001). Survival among morbidly obese compared to other group was lower at 30-day, 1-, 5- , and 10-years. After adjustment for known risks, morbid obesity was associated with higher post-transplant 30-day (HR 1.64, 95% CI 1.37-1.97), 1-year (HR 1.50, 1.33-1.69), 5-year (HR 1.36, 1.24-1.49), and 10-year mortality risk (HR 1.28, 1.19-1.39). Survival following HT was significantly lower in recipients with morbid obesity. The risk associated with BMI≥ 35kg/m2 should be considered at the time of transplant assessment.