Waitlist Weight Changes Impact Survival Following Heart Transplantation

Abstract

Purpose The purpose of this study was to investigate the impact of weight change in waitlisted candidates on posttransplant outcomes following orthotopic heart transplantation (OHT). Methods The UNOS database was queried to identify adult (≥18 years) patients undergoing isolated, primary OHT from 1/1/2010 to 3/20/2020. Percent weight change was calculated from time of waitlisting to OHT, and patients were stratified into 3 cohorts based on weight change. The primary outcome was one-year survival among cohorts, and multivariable Cox Proportional Hazards modeling was used for risk-adjustment, including adjustment for time spent on waitlist. A secondary analysis was conducted to compare outcomes of recipients waitlisted ≥90 days. Results 57,107 patients were included, 48,299 (84.6%) with stable weight, 2,927 (5.1%) with ≥5% weight loss, and 5,881 (10.3%) with ≥5% weight gain. Median age was similar across cohorts with predominantly white recipients with non-ischemic cardiomyopathy. Waitlist time was longest in patients with weight gain and shortest in those with stable weight (417 vs 74 days, P Conclusion OHT recipients with ≥5% weight loss while on the waitlist comprise a small, but higher risk population with increased rates of postoperative complications and decreased survival. Efforts focused on nutritional optimization and preventing weight loss while awaiting OHT appear warranted.