Zach Rollins MD , Ye In Christopher Kwon BA , Graham Gardner MD , Elizabeth Bashian MD , Matthew Ambrosio MS , Inna F. Tchoukina MD , Keyur Shah MD , Rahul Rajeev MD , Josue Chery MD , Vigneshwar Kasirajan MD , Zubair A. Hashmi MD
{"title":"年龄和肥胖对心脏移植结果的影响","authors":"Zach Rollins MD , Ye In Christopher Kwon BA , Graham Gardner MD , Elizabeth Bashian MD , Matthew Ambrosio MS , Inna F. Tchoukina MD , Keyur Shah MD , Rahul Rajeev MD , Josue Chery MD , Vigneshwar Kasirajan MD , Zubair A. Hashmi MD","doi":"10.1016/j.xjon.2025.02.022","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>Between 2014 and 2023, there were 15,839 NR; 869 HRA; 8187 HRB; and 202 HRAB patients. There was a significant difference in overall survival by Kaplan-Meier evaluation between the 4 groups, with worse survival in the high-risk groups (<em>P</em> < .001). The hazard ratio for mortality in the HRB, HRA, and HRAB groups was 1.21, 1.23, and 1.72, respectively (<em>P</em> < .05). However, even recipients in the HRAB group had 5-year survival rates of 66.8%.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 253-263"},"PeriodicalIF":1.9000,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Influences of age and obesity on heart transplant outcomes\",\"authors\":\"Zach Rollins MD , Ye In Christopher Kwon BA , Graham Gardner MD , Elizabeth Bashian MD , Matthew Ambrosio MS , Inna F. Tchoukina MD , Keyur Shah MD , Rahul Rajeev MD , Josue Chery MD , Vigneshwar Kasirajan MD , Zubair A. Hashmi MD\",\"doi\":\"10.1016/j.xjon.2025.02.022\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>Between 2014 and 2023, there were 15,839 NR; 869 HRA; 8187 HRB; and 202 HRAB patients. There was a significant difference in overall survival by Kaplan-Meier evaluation between the 4 groups, with worse survival in the high-risk groups (<em>P</em> < .001). The hazard ratio for mortality in the HRB, HRA, and HRAB groups was 1.21, 1.23, and 1.72, respectively (<em>P</em> < .05). However, even recipients in the HRAB group had 5-year survival rates of 66.8%.</div></div><div><h3>Conclusions</h3><div>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.</div></div>\",\"PeriodicalId\":74032,\"journal\":{\"name\":\"JTCVS open\",\"volume\":\"25 \",\"pages\":\"Pages 253-263\"},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2025-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JTCVS open\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2666273625000749\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JTCVS open","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2666273625000749","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Influences of age and obesity on heart transplant outcomes
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.
Results
Between 2014 and 2023, there were 15,839 NR; 869 HRA; 8187 HRB; and 202 HRAB patients. There was a significant difference in overall survival by Kaplan-Meier evaluation between the 4 groups, with worse survival in the high-risk groups (P < .001). The hazard ratio for mortality in the HRB, HRA, and HRAB groups was 1.21, 1.23, and 1.72, respectively (P < .05). 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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