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DOI: 10.1055/s-2007-967486
Heart transplantation in heart failure: the prognostic importance of body mass index at time of surgery and subsequent weight changes
Objective: We studied the effect of body mass, and of change in body mass index (BMI) following heart transplantation (HTx), on survival following HTx in 1902 consecutive patients undergoing HTx between 1984 and 1999.
Methods: Patients were recruited from three centres: UK (n=553), Germany (N=971) and USA (N=378). To compare outcome with patients without transplantation, a population of patients suitable for Htx was selected on the basis of NYHA class III–IV, a low left ventricular ejection fraction (≤30%) and peak oxygen consumption (≤16ml.kg-1.min-1) (N=237).
Results: In the transplanted patients, average duration of follow up of 80 months in survivors. There was no effect of BMI on survival expressed either as a continuous variable (hazard ratio 1.01; 0.99–1.03) or as a categorical variable with the patients divided into quintiles. Loss of weight between transplant and 3 months was strongly associated with worse survival (hazard ratio (95% CI) 2.6 (1.4–4.7) compared with those who gained weight. In the reference patients without transplant, increasing body mass index was significantly related to survival: each increment in BMI of 1.0 carried a hazard ratio of 0.92 (0.87–0.98).
Conclusions: Chronic heart failure patients with cardiac cachexia, can be transplanted successfully. Presence of cardiac cachexia need not to be an exclusion criterion for HTx. Underweight patients, because of the underlying extremely poor prognosis, have a greater benefit from transplantation compared to patients with higher body weight. Body weight increases in the first year after transplantation are not associated.