title: Post-operative obesity and cachexia are risk factors for morbidity and mortality after heart transplant: multi-institutional study of post-operative weight change.
abstract: BACKGROUND
  The relationship between post-heart transplant cachexia and obesity with subsequent morbidity and mortality has not yet been reported. Therefore, the purposes of this study were to: (1) describe change in body mass index (BMI) from before transplant through 5 years after transplant; (2) identify risk factors for increased BMI at 1 year post-transplant; and (3) determine whether post-transplant BMI is associated with post-transplant morbidity and mortality.
  
  
  METHODS
  Patients (n = 3,540) were from a non-random sample having received a heart transplant between January 1, 1996 and December 31, 2001 at 33 institutions of the Cardiac Transplant Research Database (CTRD). Patients were divided into groups using cut-offs for categories of BMI. Data were assessed according to frequencies, measures of central tendency, Pearson correlations, chi-square tests, multiple regression and stratified actuarial analyses with log-rank tests for comparisons. The level of statistical significance was set at p = 0.05.
  
  
  RESULTS
  The number of obese patients increased significantly from immediately before heart transplant to 5 years later (17% vs 38%) (p < 0.0001). Risk factors for increased BMI at 1 year after heart transplant (explaining 56% of variance) included increased BMI at transplant, younger age, black race, non-ischemic etiology of heart disease, Status I at time of transplant and non-use of mycophenolate mofetil. Patients who were underweight or obese at 1 year post-transplant were at greater risk for rejection over time than patients who were of normal weight or overweight (p = 0.009).
  
  
  CONCLUSIONS
  Both demographic and clinical factors are related to increased BMI at 1 year after heart transplantation. Post-transplant cachexia and obesity are risk factors for poor clinical outcomes after heart transplantation.
authors.affiliation: Northwestern Memorial Hospital, Chicago, Illinois, USA. kgrady@nmh.org
authors.forename: Kathleen L
authors.initials: KL
authors.lastname: Grady
authors.forename: David
authors.initials: D
authors.lastname: Naftel
authors.forename: Salpy V
authors.initials: SV
authors.lastname: Pamboukian
authors.forename: O H
authors.initials: OH
authors.lastname: Frazier
authors.forename: Paul
authors.initials: P
authors.lastname: Hauptman
authors.forename: John
authors.initials: J
authors.lastname: Herre
authors.forename: Howard
authors.initials: H
authors.lastname: Eisen
authors.forename: Frank
authors.initials: F
authors.lastname: Smart
authors.forename: Robert
authors.initials: R
authors.lastname: Bourge
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D044383:Black People; D015992:Body Mass Index; D002100:Cachexia / Q000150:complications* / Q000453:epidemiology; D005260:Female; D006084:Graft Rejection; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000453:epidemiology / Q000208:ethnology; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D015430:Weight Gain