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Published on: April 27, 2019
Impact of waitlist weight change on outcomes in heart transplant recipients: a UNOS database analysis
Melissa A Austin1, Danial Ahmad1, Jake L Rosen1
1Division of Cardiac Surgery, Thomas Jefferson University, 1025 Walnut Street, College Building, Suite 607, Philadelphia, PA, 19107, USA.
Insights
Weight changes before heart transplantation (HTx) significantly impact survival. Weight loss generally worsens outcomes, while modest weight gain may benefit non-obese patients, but cachectic patients need to gain weight for better survival.
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Research
Background:
- Limited data exists on the impact of dynamic weight changes prior to heart transplantation (HTx).
- Previous studies focused on pre-transplant weight, not weight fluctuations during the waitlist period.
Purpose of the Study:
- To investigate the combined effect of heart transplantation (HTx) listing weight and weight changes during the waitlist period on post-transplant survival.
- To analyze the continuous relationship between weight changes and survival outcomes after HTx.
Main Methods:
- Utilized the UNOS database to identify adult patients listed for HTx between 1987 and 2020.
- Employed 3D restricted cubic spline analysis and Cox proportional hazards models to assess survival relative to BMI/weight changes and listing BMI.
- Analyzed continuous predictor variables for post-transplant survival.
Main Results:
- A total of 9,628 patients underwent HTx, with 53% experiencing weight loss and 47% weight gain on the waitlist.
- Weight loss exceeding 3 BMI points or 10 kg was linked to an increased hazard of death, regardless of listing BMI.
- Non-obese patients showed improved survival with modest weight gain (1-4 BMI points or 5-15 kg), while cachectic patients (BMI < 18.5) had worse survival if they did not gain weight.
Conclusions:
- The impact of weight change on heart transplantation (HTx) outcomes is contingent upon the patient's initial Body Mass Index (BMI).
- Significant weight loss before HTx is associated with poorer survival, whereas some weight gain can benefit non-obese recipients.
- Weight management strategies should be tailored based on listing BMI to optimize post-transplant survival.
Background:
While the effect of pre-transplant weight on patient outcomes following heart transplantation (HTx) has previously been studied, data regarding the impact of dynamic weight change prior to HTx are extremely limited.
Objectives:
We sought to elucidate the interaction between HTx listing weight and weight change while waitlisted, and explore how that interaction impacts post-HTx survival in a continuous manner.
Methods:
Adult patients listed for HTx from 1987 to 2020 were identified from UNOS database. Three-dimensional restricted cubic spline analysis explored post-HTx survival relative to both changes in BMI/weight and BMI at time of HTx listing. Continuous predictor variables were analyzed with Cox proportional hazards method.
Results:
9,628 included patients underwent HTx. Median recipient age was 55 [IQR 46-62] years, and 21% were females. 53% of patients lost while 47% gained weight on the waitlist. Median BMI (27.6 kg/m2 [24.3-31.3] vs. 27.4 kg/m2 [24.2-30.9], paired p < 0.001) and weight (84.8 kg [73.0-98.0] kg vs. 84.4 kg [72.6-96.6], p < 0.001) were similar at listing and transplant. One-year survival was 89.3%. Weight loss over 3 BMI points or 10 kg was associated with higher hazard of death irrespective of listing BMI. In non-obese patients, some weight gain (1-4 BMI points or 5-15 kg) was associated with improved survival. In cachectic patients (BMI < 18.5), failure to gain weight was associated with worse survival.
Conclusions:
Impact of weight change varies depending on listing BMI. While a survival benefit is seen in non-obese patients who gain some weight, significant weight loss is associated with poorer survival.
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