Survival after OHT in Patients with BMI >35 with and without Diabetes

Abstract

PurposeOHT recipients with BMI >35 have worse survival than those with BMI <35. Diabetes is an independent risk factor for mortality in recipients. This study evaluates the impact of diabetes on mortality after OHT in patients with BMI >35.MethodsRecipient and donor characteristics were compared using chi-square and t-tests. Multivariable Cox proportional hazards model examined the risk of death in OHT according to presence or absence of diabetes and BMI>35. All covariates with statistical significance (p<0.2) were adjusted for. Kaplan Meier curves were constructed to analyze the association between diabetes and survival.ResultsFrom 2008-2017, 560 diabetic and 808 non-diabetic patients were identified in the UNOS database with BMI >35 who received OHT. Compared to non-diabetics, patients with diabetes were older (p<.001), had higher creatinine (p<.001), lower bilirubin (p=0.02), fewer waitlist months (p=0.0008), and donor was less likely to be on inotropes (p=0.02). Kaplan Meier analysis showed no statistically significant difference in survival between groups (Log-rank p=0.92). In Cox models, there was no difference in survival for the diabetic group compared to the non-diabetics (HR=0.95, 95% CI [0.76,1.18]). Recipient factors found to be significantly associated with an increased risk of death were increasing bilirubin (HR=1.17, 95% CI [1.10,1.24]), LVAD (HR=1.25, 95% CI [1.006,1.56]), and intubation (HR=2.00, 95% CI [1.06,3.78]). Increasing donor age (HR=1.01, 95% CI [1.00,1.02]) and donor cigarette use (HR=1.35, 95% CI [1.01,1.80]) were statistically significant risk factors. Increasing ischemic time resulted in a statistically significant increased hazard of death (HR=1.11, 95% CI [1.01-1.21]).ConclusionThis registry study demonstrates that in OHT recipients with BMI >35, there is no statistically significant difference in five year survival in recipients with or without diabetes. These results should encourage continued consideration for OHT listing in patients with BMI >35 with coexisting diabetes. OHT recipients with BMI >35 have worse survival than those with BMI <35. Diabetes is an independent risk factor for mortality in recipients. This study evaluates the impact of diabetes on mortality after OHT in patients with BMI >35. Recipient and donor characteristics were compared using chi-square and t-tests. Multivariable Cox proportional hazards model examined the risk of death in OHT according to presence or absence of diabetes and BMI>35. All covariates with statistical significance (p<0.2) were adjusted for. Kaplan Meier curves were constructed to analyze the association between diabetes and survival. From 2008-2017, 560 diabetic and 808 non-diabetic patients were identified in the UNOS database with BMI >35 who received OHT. Compared to non-diabetics, patients with diabetes were older (p<.001), had higher creatinine (p<.001), lower bilirubin (p=0.02), fewer waitlist months (p=0.0008), and donor was less likely to be on inotropes (p=0.02). Kaplan Meier analysis showed no statistically significant difference in survival between groups (Log-rank p=0.92). In Cox models, there was no difference in survival for the diabetic group compared to the non-diabetics (HR=0.95, 95% CI [0.76,1.18]). Recipient factors found to be significantly associated with an increased risk of death were increasing bilirubin (HR=1.17, 95% CI [1.10,1.24]), LVAD (HR=1.25, 95% CI [1.006,1.56]), and intubation (HR=2.00, 95% CI [1.06,3.78]). Increasing donor age (HR=1.01, 95% CI [1.00,1.02]) and donor cigarette use (HR=1.35, 95% CI [1.01,1.80]) were statistically significant risk factors. Increasing ischemic time resulted in a statistically significant increased hazard of death (HR=1.11, 95% CI [1.01-1.21]). This registry study demonstrates that in OHT recipients with BMI >35, there is no statistically significant difference in five year survival in recipients with or without diabetes. These results should encourage continued consideration for OHT listing in patients with BMI >35 with coexisting diabetes.