Key result
Higher recipient BMI is linked to ~11% greater postoperative mortality risk without sharp survival cutoffs.
Why the study?
Heart transplant guidelines for recipient BMI have variable cutoffs, necessitating updated nonlinear estimates of postoperative risk to evaluate the relevance of existing cutoffs.
Does recipient body mass index affect overall survival in adults following isolated heart transplantation?
Cohort (n=30,787)
Yes
Does recipient body mass index affect overall survival in adults following isolated heart transplantation?
Effect estimate: HR 1.11 (95% CI 1.07-1.15)
p-value: p=<0.01
Postoperative survival risk after heart transplantation increases linearly with BMI starting at 26, challenging the use of strict cutoffs at 30 or 35.
Challenges strict BMI cutoffs for transplant eligibility; hypothesis-generating and should not yet change practice.
Background: Guidelines regarding recipient's body mass index (BMI) for heart transplant are evolving with variable cutoffs depending on the country and institution. It is imperative to provide updated nonlinear estimates of postoperative risk attributable to a recipient's BMI to evaluate the relevance of existing cutoffs. Methods: A total of 30,787 patients were analyzed from the United Network for Organ Sharing (UNOS) database. Patients receiving an isolated heart transplant ages 18 and older since 2010 were included. Overall survival was the primary outcome. A multivariate Cox proportional hazards model was applied and included a penalized smoothing spline term for recipient BMI and risk factors such as diabetes. We assessed the overall significance of the nonlinear penalized spline terms using an asymptotic Wald test. Results: < 0.01). The hazard ratio (HR) appeared to grow linearly in BMI at an inflection point of BMI = 26. No inflection point was observed at either of the International Society for Heart and Lung Transplantation recommended cutoffs of BMI = 30 (HR 1.11, confidence interval [CI] 1.07-1.15) or BMI = 35 (HR 1.29, CI 1.24-1.37). Conclusions: After multivariable adjustment, there is no sharp cutoff in survival risk at either BMI = 30 or BMI = 35. Unlike previously reported, postoperative survival risk grows approximately linearly in the BMI range from 26 to 40.
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Dale et al. (2024) conducted a cohort in Isolated heart transplantation (n=30,787). Body mass index (BMI) was evaluated on Overall survival (HR 1.11, 95% CI 1.07-1.15, p=<0.01). Recipient body mass index (BMI) showed a linear increase in postoperative mortality risk starting at BMI 26, with no sharp survival cutoff at BMI 30 (HR 1.11; 95% CI 1.07-1.15) or BMI 35.
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