Key result
Low muscle mass linked to ~31% higher ICU mortality in heart transplant recipients.
Why the study?
Heart transplant recipients in the ICU face high risk of adverse outcomes, with growing interest in body composition parameters like muscle and fat mass as modifiable survival predictors.
Do body composition parameters such as low muscle mass or increased fat mass predict ICU mortality in adult heart transplant recipients?
Meta-Analysis (n=1,276)
Do body composition parameters such as low muscle mass or increased fat mass predict ICU mortality in adult heart transplant recipients?
Effect estimate: HR 1.31 (95% CI 1.07-1.96)
Low skeletal muscle mass, but not fat mass, is a significant independent predictor of ICU mortality in heart transplant recipients, highlighting the prognostic importance of sarcopenia in this population.
May warrant muscle mass assessment in heart transplant recipients; reinforces sarcopenia's prognostic role in ICU risk stratification.
Introduction: Heart transplant recipients admitted to the intensive care unit (ICU) are at high risk of adverse outcomes, and there is growing interest in body composition particularly muscle and fat mass as a modifiable predictor of survival. This systematic review and meta-analysis evaluated the association between body composition parameters and ICU mortality in heart transplant patients. Methods: We systematically searched PubMed, Embase, and Cochrane CENTRAL up to June 2025 for cohort studies assessing muscle mass, fat mass, and ICU mortality among adult heart transplant recipients. Hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Heterogeneity was assessed using the I2 statistic. Subgroup and sensitivity analyses were performed to find possible confounders. Artificial Intelligence assist tools were used for improving fluidity, grammar and structure of the writing, has not been included in data curation, analysis and interpretation. Results: Eleven cohort studies including 1,276 heart transplant patients were identified, with five studies contributing to quantitative meta-analysis. Low muscle mass was significantly associated with increased ICU mortality (HR: 1.31, 95% CI: 1.07–1.96; I2 = 47%; 4 studies). This relationship remained stable across sensitivity and subgroup analyses. In contrast, increased fat mass showed no significant association with ICU mortality (pooled adjusted HR: 0.82, 95% CI: 0.34–2.32; I2 = 77%). Similarly, higher abdominal fat was not significantly associated with mortality risk. Conclusions: Among heart transplant recipients in the ICU, low skeletal muscle mass is a significant and independent predictor of mortality, whereas fat mass including abdominal adiposity does not appear to impact survival. These findings underscore the importance of assessing and addressing sarcopenia in perioperative and critical care management. Further prospective studies are needed to define targeted interventions to improve outcomes in this patient population.
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Merchant et al. (2026) conducted a meta-analysis in Heart transplant recipients in the intensive care unit (n=1,276). Low muscle mass was evaluated on ICU mortality (HR 1.31, 95% CI 1.07-1.96). Low muscle mass in heart transplant recipients in the ICU was significantly associated with increased ICU mortality (HR 1.31; 95% CI 1.07-1.96), whereas fat mass showed no significant association.
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