Abstract
<h3>Purpose</h3> Up to 70% of heart failure patients are malnourished which may affect post heart transplant (HT) outcomes. Studies assessing malnutrition pre-HT using validated tools are limited. This study aimed to assess if nutritional status using a validated tool and body mass index (BMI) impacted post-HT outcomes. <h3>Methods</h3> Single centre retrospective study of consecutive patients undergoing HT July 2015 to June 2021. Pre-HT nutritional status was assessed using the Subjective Global Assessment (SGA) tool and anthropometric data. Outcome measures included Intensive Care Unit (ICU) and total length of stay (LOS) at time of HT; post-HT infection and mortality (to 12-months). Results reported as mean±SD. <h3>Results</h3> 103 patients underwent HT during the study (mean age 50.3±12.2 years, 74% male). SGA at HT completed for 85.4% (n=88) of patients, 28.4% (n=25) were mild or moderately malnourished (SGA B), of these 24% (n=6) were overweight (BMI ≥25kg/m<sup>2</sup>). Malnourished patients had a longer but not statistically significant ICU LOS (18.5±26.8 days) compared to well-nourished patients (12.3±15.7 days, <i>p</i>=0.22). Total LOS between groups was not significant (malnourished 31.3±22.5 vs well-nourished 41.6±52.0 days; <i>p=0.37).</i> Malnourished patients experienced more post-HT infections compared to well-nourished patients (28% vs 22%, <i>p</i>=0.58). 16 patients died within 12 months post-HT and were more likely to be malnourished (n=7 of 12 SGAs completed, 58%, <i>p</i>=0.03). Obesity (BMI≥30kg/m<sup>2</sup>) was associated with significantly longer LOS (60.9±69.1 vs 28.8±28.5 days, <i>p</i>=0.002), but not ICU LOS (<i>p</i>=0.22). Overweight (BMI 25-29.9kg/m<sup>2</sup>) patients had higher rates of infections than healthy weight and obese patients (47.6% vs 23.8% and 28.6%, <i>p</i>=0.68). BMI had no impact on 12-month mortality post-HT (<i>p</i>=0.55). <h3>Conclusion</h3> Malnourished patients had a significant increased risk of 12-month mortality and experienced increased ICU LOS and infection rates post-HT. Obesity (BMI ≥30 kg/m<sup>2</sup>) was significantly associated with increased total LOS. Findings highlight the presence of potentially modifiable nutrition risk factors in HT patients. Nutrition assessments pre-and post-HT provide an opportunity to identify at risk patients, optimise nutritional status and may improve post-HT outcomes. This study was limited by small sample size. Future larger studies to investigate the impact of malnutrition and BMI on HT outcomes are warranted.
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