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Orthotopic heart transplantation in patients with metabolic risk factors
Arman Kilic1, John V Conte, Ashish S Shah
1Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Medical Institutions Baltimore, Maryland, USA.
Insights
Metabolic risk factors like hypertension, diabetes, and obesity significantly increase mortality after heart transplantation. Each additional risk factor exponentially raises the risk of death and lowers survival rates post-orthotopic heart transplantation (OHT).
Area of Science:
- Cardiology
- Transplantation Medicine
- Public Health
Background:
- Orthotopic heart transplantation (OHT) is a life-saving procedure.
- Metabolic risk factors are common in patients eligible for OHT.
- The impact of these factors on post-transplant outcomes requires further investigation.
Purpose of the Study:
- To assess the association between metabolic risk factors and mortality rates following OHT.
- To quantify the independent and combined effects of hypertension, diabetes mellitus, and obesity on post-OHT survival.
Main Methods:
- Analysis of adult patients who underwent OHT between 1998 and 2008 using the United Network for Organ Sharing registry.
- Cox proportional hazards regression models were employed to evaluate the impact of metabolic risk factors on mortality.
- Kaplan-Meier survival estimates and log-rank tests were used to compare survival across patient groups.
Main Results:
- A total of 15,960 patients were included in the study.
- Hypertension, diabetes, and obesity each independently increased the likelihood of mortality post-OHT.
- An exponential increase in mortality was observed with each additional risk factor, with patients having all three facing a 63% higher mortality risk.
Conclusions:
- The presence of multiple metabolic risk factors in OHT recipients is linked to significantly higher postoperative mortality.
- These findings underscore the importance of managing metabolic health in heart transplant candidates and recipients.
- Interventions targeting hypertension, diabetes, and obesity may improve long-term survival after OHT.
Background:
The aim of this study was to evaluate the impact of metabolic risk factors on mortality rates after orthotopic heart transplantation (OHT).
Methods:
Adult patients undergoing OHT between 1998 and 2008 were identified in the United Network for Organ Sharing registry. The impact of metabolic risk factors (hypertension, diabetes mellitus, and obesity) on mortality post-OHT was evaluated in a Cox proportional hazards regression analysis adjusted for other variables associated with survival in univariate analysis (exploratory p value<0.2). Kaplan-Meier survival estimates were compared with the log-rank test.
Results:
A total of 15,960 eligible patients underwent OHT during the study period. There were 6,368 (39.9%) patients with none of these risk factors, 6,138 (38.5%) with 1 risk factor, 2,811 (17.6%) with 2 risk factors, and 643 (4.0%) who had all 3 risk factors. After adjusting for other significant variables influencing survival, each individual risk factor independently increased the likelihood of mortality post-OHT (hypertension: HR 1.10 [1.03 to 1.17]; diabetes: HR 1.22[1.13 to 1.31]; obesity: HR 1.17 [1.10 to 1.26], each p<0.01). There was an exponential trend of increasing mortality with the addition of each risk factor (r2=0.99, p<0.001) such that patients with all 3 risk factors had a 63% increased mortality compared with those with no risk factors (HR 1.63 [1.42 to 1.88], p<0.001). There was also a significant trend in declining 5-year survival rates with an increasing number of risk factors: 0 (74.7%), 1 (71.3%), 2 (68.2%), and 3 (63.1%) (p<0.001).
Conclusions:
This large-cohort study demonstrates that an increasing number of metabolic risk factors in OHT recipients is associated with exponential increases in postoperative mortality rates.
