Impact of waitlist weight change on outcomes in heart transplant recipients: a UNOS database analysis.

IF 1.1 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

General Thoracic and Cardiovascular Surgery Pub Date : 2024-10-03 DOI:10.1007/s11748-024-02078-y

Melissa A Austin, Danial Ahmad, Jake L Rosen, Matthew P Weber, Indranee Rajapreyar, Jesus Eduardo Rame, Rene J Alvarez, John W Entwistle, Howard T Massey, Vakhtang Tchantchaleishvili

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引用次数: 0

Abstract

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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等待名单体重变化对心脏移植受者预后的影响：UNOS 数据库分析。

背景：虽然移植前体重对心脏移植（HTx）后患者预后的影响已有研究，但有关心脏移植前动态体重变化影响的数据却极为有限：我们试图阐明心脏移植手术前体重与等待期间体重变化之间的相互作用，并探索这种相互作用如何以连续的方式影响心脏移植手术后的存活率：方法：我们从 UNOS 数据库中找到了 1987 年至 2020 年期间列入 HTx 名单的成年患者。三维受限立方样条分析探讨了相对于 BMI/体重变化和 HTx 排期时 BMI 的 HTx 后存活率。连续预测变量采用 Cox 比例危险法进行分析：共有 9628 名患者接受了高温热疗。受术者年龄中位数为 55 [IQR 46-62] 岁，21% 为女性。53%的患者体重减轻，47%的患者体重增加。中位体重指数（27.6 kg/m2 [24.3-31.3] vs. 27.4 kg/m2 [24.2-30.9]，配对 p 结论：体重变化的影响因候选名单而异：体重变化的影响因列出的 BMI 而异。体重增加的非肥胖患者可获得生存益处，而体重大幅下降的患者生存率较低。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

General Thoracic and Cardiovascular Surgery Medicine-Pulmonary and Respiratory Medicine

CiteScore

2.70

自引率

8.30%

发文量

142

期刊介绍： The General Thoracic and Cardiovascular Surgery is the official publication of The Japanese Association for Thoracic Surgery and The Japanese Association for Chest Surgery, the affiliated journal of The Japanese Society for Cardiovascular Surgery, that publishes clinical and experimental studies in fields related to thoracic and cardiovascular surgery.