Key result
High-risk heart transplant recipients with both BMI >30 and age >70 years had the worst overall survival compared to normal risk recipients, yet still achieved a 5-year survival rate of 66.8%.
Why the study?
Obesity and older age are risk factors for worse prognosis after heart transplantation, prompting evaluation of 5-year outcomes for patients with BMI >30, age >70 years, or both compared to normal-risk recipients in the modern era.
Do high-risk BMI (>30) and/or high-risk age (>70 years) reduce overall survival in adult heart transplant recipients?
Cohort
Yes
Do high-risk BMI (>30) and/or high-risk age (>70 years) reduce overall survival in adult heart transplant recipients?
Heart transplant recipients with both age >70 and BMI >30 have worse overall survival compared to normal risk patients, but still achieve a reasonable 5-year survival rate of 66.8%, suggesting transplantation remains valuable in this high-risk group.
May support transplant in select older obese recipients; extends risk stratification data but requires prospective validation.
Objective: Obesity and older age have both been identified as risk factors for a worse long-term prognosis after heart transplantation. We sought to determine the 5-year outcomes for heart transplant patients with high-risk body mass index (BMI) >30 (HRB), high-risk age >70 years (HRA), or both (HRAB) as compared with recipients with normal risk (NR) in the modern era. Methods: Records of isolated heart transplants in the United States from 2014 to 2023 were obtained for adults older than 18 years. BMI and age cut-off was identified on spline analysis. Survival curves were built for overall survival using a Kaplan-Meier method, with a log-rank test used to test for differences between groups. Risk adjusted Cox regression was performed on variables potentially influencing overall survival. However, even recipients in the HRAB group had 5-year survival rates of 66.8%. Conclusions: Overall survival is worse in recipients in the HRA, HRB, or HRAB groups than in recipients in the NR group but similar between patients with isolated BMI >30 or age >70 years. Patients with both increased BMI >30 and age >70 years had the worst overall survival. However, the 5-year survival even for HRAB suggests the value of transplantation even if patients are at high risk.
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Rollins et al. (2025) conducted a cohort in Heart transplantation. High-risk BMI >30 and/or age >70 years vs. Normal risk recipients was evaluated on Overall survival (p=<.05). High-risk heart transplant recipients with both BMI >30 and age >70 years had the worst overall survival compared to normal risk recipients, yet still achieved a 5-year survival rate of 66.8%.
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