Heart Transplantation in Heart Failure: The Prognostic Importance of Body Mass Index at Time of Surgery and Subsequent Weight Changes
Key result
Baseline body mass index did not affect survival following heart transplantation (HR 1.02; 95% CI 0.99-1.04), but weight loss at 3 months post-transplant was associated with worse survival.
Why the study?
Does baseline BMI and subsequent weight change affect survival in patients undergoing heart transplantation for end-stage chronic heart failure?
Population
2,139 patients with end-stage chronic heart failure, including 1,902 consecutive patients undergoing heart…
Comparison
Heart transplantation with assessment of… vs Patients suitable for transplantation who did…
Design
Cohort
Follow-up
average 80 (SD 34) months
Authors
Discussion
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Implication
Does not support BMI-based exclusion from transplantation; hypothesis-generating for early weight loss as a risk marker.
Study Design
Type
Cohort (n=2,139)
Multicenter
Yes
Structured PICO
Does baseline BMI and subsequent weight change affect survival in patients undergoing heart transplantation for end-stage chronic heart failure?
P
Population
2,139 patients with end-stage chronic heart failure (1,902 transplanted and 237 non-transplanted comparators) followed for an average of 80 months.
E
Exposure
Heart transplantation with assessment of baseline body mass index (BMI) and subsequent weight changes.
C
Comparator
Patients suitable for transplantation (symptoms, LVEF ≤30%, peak oxygen consumption ≤16 ml/kg/min) who did not receive a transplant (n=237).
O
Outcome
Survival following transplantation.hard clinical
Main Result
Hazard Ratio: 1.02 (95% CI 0.99–1.04)
Underweight status should not be an exclusion criterion for heart transplantation, as baseline BMI does not adversely affect survival, though early post-transplant weight loss is associated with worse outcomes.
Cite This Study
Clark et al. (2007) conducted a cohort in end-stage chronic heart failure (n=2,139). Baseline body mass index (BMI) and subsequent weight change vs. Non-transplanted patients was evaluated on survival (HR 1.02, 95% CI 0.99-1.04). Baseline body mass index did not affect survival following heart transplantation (HR 1.02; 95% CI 0.99-1.04), but weight loss at 3 months post-transplant was associated with worse survival.