title: Pretransplant cachexia and morbid obesity are predictors of increased mortality after heart transplantation.
abstract: BACKGROUND
  Extremes in body weight are a relative contraindication to cardiac transplantation.
  
  
  METHODS
  We retrospectively reviewed 474 consecutive adult patients (377 male, 97 female, mean age 50.3+/-12.2 years), who received 444 primary and 30 heart retransplants between January of 1992 and January of 1999. Of these, 68 cachectic (body mass index [BMI]<20 kg/m2), 113 overweight (BMI=>27-30 kg/m2), and 55 morbidly obese (BMI>30 kg/m2) patients were compared with 238 normal-weight recipients (BMI=20-27 kg/m2). We evaluated the influence of pretransplant BMI on morbidity and mortality after cardiac transplantation. Kaplan-Meier survival distribution and Cox proportional hazards model were used for statistical analyses.
  
  
  RESULTS
  Morbidly obese as well as cachectic recipients demonstrated nearly twice the 5-year mortality of normal-weight or overweight recipients (53% vs. 27%, respectively, P=0.001). An increase in mortality was seen at 30 days for morbidly obese and cachectic recipients (12.7% and 17.7%, respectively) versus a 30-day mortality rate of 7.6% in normal-weight recipients. Morbidly obese recipients experienced a shorter time to high-grade acute rejection (P=0.004) as well as an increased annual high-grade rejection frequency when compared with normal-weight recipients (P=0.001). By multivariable analysis, the incidence of transplant-related coronary artery disease (TCAD) was not increased in morbidly obese patients but cachectic patients had a significantly lower incidence of TCAD (P=0.05). Cachectic patients receiving oversized donor hearts had a significantly higher postoperative mortality (P=0.02).
  
  
  CONCLUSIONS
  The risks of cardiac transplantation are increased in both morbidly obese and cachectic patients compared with normal-weight recipients. However, the results of cardiac transplantation in overweight patients is comparable to that in normal-weight patients. Recipient size should be kept in mind while selecting patients and the use of oversized donors in cachectic recipients should be avoided.
authors.affiliation: Division of Cardiothoracic Surgery, Columbia Presbyterian Medical Center, Columbia University, New York, NY 10032, USA.
authors.forename: K
authors.initials: K
authors.lastname: Lietz
authors.forename: R
authors.initials: R
authors.lastname: John
authors.forename: E A
authors.initials: EA
authors.lastname: Burke
authors.forename: J H
authors.initials: JH
authors.lastname: Ankersmit
authors.forename: J D
authors.initials: JD
authors.lastname: McCue
authors.forename: Y
authors.initials: Y
authors.lastname: Naka
authors.forename: M C
authors.initials: MC
authors.lastname: Oz
authors.forename: D M
authors.initials: DM
authors.lastname: Mancini
authors.forename: N M
authors.initials: NM
authors.lastname: Edwards
mesh_terms: D000328:Adult; D044383:Black People; D015992:Body Mass Index; D001835:Body Weight; D001926:Brain Death; D002100:Cachexia / Q000503:physiopathology*; D003327:Coronary Disease / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology; D006321:Heart / Q000033:anatomy & histology; D016027:Heart Transplantation / Q000276:immunology / Q000401:mortality* / Q000502:physiology*; D006650:Histocompatibility Testing; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City; D009767:Obesity, Morbid / Q000503:physiopathology*; D011379:Prognosis; D012016:Reference Values; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D014019:Tissue Donors / Q000706:statistics & numerical data; D044465:White People; D001741:Black or African American