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The effect of body mass index on survival following heart transplantation: do outcomes support consensus guidelines?
Mark J Russo1, Kimberly N Hong, Ryan R Davies
1Division of Cardiothoracic Surgery, Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, NY, USA. mr2143@columbia.edu
Insights
Underweight and severe obesity (BMI ≥35) are linked to worse outcomes after heart transplants. Mild obesity (BMI 30-34.99) did not significantly impact survival in heart transplant recipients.
Area of Science:
- Cardiology
- Transplantation Medicine
- Obesity Research
Background:
- Current heart transplant criteria suggest a BMI below 30 kg/m².
- Limited and conflicting data support these BMI recommendations.
- This study investigates the impact of pre-transplant BMI on outcomes.
Purpose of the Study:
- To determine the relationship between body mass index (BMI) at the time of transplant and posttransplant survival and morbidity.
- To evaluate the impact of different BMI categories on heart transplant outcomes.
Main Methods:
- Analysis of de-identified patient data from the United Network of Organ Sharing.
- Included 19,593 adult orthotopic heart transplant recipients transplanted between 1995 and 2005.
- Recipients stratified by BMI: underweight, normal, overweight, obesity class I, and obesity class II/III.
Main Results:
- Underweight and obesity class II/III (BMI ≥35) recipients showed significantly diminished posttransplant survival.
- Overweight and obesity class I (BMI 30-34.99) recipients did not have significantly reduced survival.
- Median survival varied from 8.31 years (underweight) to 10.20 years (normal weight).
Conclusions:
- Obesity class I (BMI 30-34.99) is not associated with significantly higher morbidity and mortality post-heart transplant.
- Underweight and severe obesity (BMI ≥35) recipients face significantly higher morbidity and mortality.
- Findings suggest a need to re-evaluate BMI thresholds for heart transplant listing.
Objective:
To determine the relationship between body mass index (BMI) at the time of transplant and posttransplant survival and morbidity.
Summary Background Data:
The recent International Society for Heart and Lung Transplantation listing criteria for heart transplantation stated that candidates should achieve a BMI <30 kg/m-or percent ideal body weight <140%-before listing for cardiac transplantation. However, data to support these recommendations are limited and often conflicting.
Methods:
United Network of Organ Sharing provided de-identified patient-level data. Analysis included 19,593 orthotopic heart transplant recipients aged >or=18 years and transplanted January 1 1995-December 31 2005. Follow-up data were provided through February 8, 2008. Recipients were stratified by BMI at the time of transplantation: BMI <18.5 (underweight), 18.5 to 24.99 (normal weight), 25 to 29.99 (overweight), 30 to 34.99 (obesity class I), and >or=35 (obesity class II/III). The primary outcome measure was post-transplant survival.
Results:
Risk-adjusted median survival in the underweight, normal weight, overweight, obesity I, and obesity II/III groups was 8.31, 10.20, 10.03, 9.51, and 9.05 years, respectively. In multivariate Cox proportional hazards regression, BMI in the overweight (HR = 1.08, 0.99-1.17; P = 0.055) and obesity I (HR = 1.05, 0.99-1.12; P = 0.091) ranges were not associated with significantly diminished survival. However, BMI in the underweight (HR = 1.26, 1.11-1.43; P < 0.001) and obesity II/III (HR = 1.18, 1.01-1.38; P = 0.030) ranges were associated with diminished posttransplant survival.
Conclusion:
Findings from this analysis do not suggest that obesity I (BMI of 30-34.99) is associated with significantly higher morbidity and mortality. However, underweight and obesity II/III recipients have significantly higher morbidity and mortality compared with other groups.
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