The effect of pre–heart transplant body mass index on posttransplant outcomes: An analysis of the ISHLT Registry Data

Barbara S. Doumouras, Chun Po S. Fan, Brigitte Mueller, Anne I. Dipchand, Cedric Manlhiot, Josef Stehlik, Heather J. Ross, Ana C. Alba

Research output: Contribution to journalArticle

Abstract

We evaluated the effect of pre–heart transplant body mass index (BMI) on posttransplant outcomes using the International Society for Heart and Lung Transplantation Registry. Kaplan-Meier analysis and a multivariable Cox proportional hazard regression model were used for all-cause mortality, and cause-specific hazard regression for cause-specific mortality and morbidity. We assessed 38 498 recipients from 2000 to 2014 stratified by pretransplant BMI. Ten-year survival was 56% in underweight, 59% in normal weight, 57% in overweight, 52% in obese class I, 54% in class II, and 47% in class III patients (P < 0.001). Mortality was increased in underweight (HR 1.29, 95% CI 1.24-1.35), obese class I (HR 1.19, 95% CI 1.13-1.26), class II (HR 1.20, 95% CI 1.08-1.32), and class III patients (HR 1.45, 95% CI 1.15-1.83). Obesity was independently associated with increased death from myocardial infarction, chronic rejection, infection, and renal dysfunction. An underweight BMI lead to increased death from infection, acute and chronic rejection, malignancy, and bleeding. Obese patients had a higher incidence of renal dysfunction, diabetes, stroke, acute rejection, cardiac allograft vasculopathy, and malignancy, and underweight recipients had increased acute rejection. We have shown that pretransplant obese and underweight patients have increased post–heart transplant mortality and morbidity. This has implications for candidate selection and posttransplant management.

Original languageEnglish (US)
Article numbere13621
JournalClinical Transplantation
Volume33
Issue number7
DOIs
StatePublished - Jul 1 2019
Externally publishedYes

Fingerprint

Thinness
Registries
Body Mass Index
Transplants
Mortality
Morbidity
Kidney
Kaplan-Meier Estimate
Infection
Proportional Hazards Models
Allografts
Neoplasms
Obesity
Stroke
Myocardial Infarction
Hemorrhage
Weights and Measures
Survival
Incidence

Keywords

  • obesity
  • patient survival
  • registry/registry analysis

ASJC Scopus subject areas

  • Transplantation

Cite this

The effect of pre–heart transplant body mass index on posttransplant outcomes : An analysis of the ISHLT Registry Data. / Doumouras, Barbara S.; Fan, Chun Po S.; Mueller, Brigitte; Dipchand, Anne I.; Manlhiot, Cedric; Stehlik, Josef; Ross, Heather J.; Alba, Ana C.

In: Clinical Transplantation, Vol. 33, No. 7, e13621, 01.07.2019.

Research output: Contribution to journalArticle

Doumouras, Barbara S. ; Fan, Chun Po S. ; Mueller, Brigitte ; Dipchand, Anne I. ; Manlhiot, Cedric ; Stehlik, Josef ; Ross, Heather J. ; Alba, Ana C. / The effect of pre–heart transplant body mass index on posttransplant outcomes : An analysis of the ISHLT Registry Data. In: Clinical Transplantation. 2019 ; Vol. 33, No. 7.
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