Heart transplantation in heart failure: the prognostic importance of body mass index at time of surgery and subsequent weight changes.
BACKGROUND
Heart transplantation is an important treatment for end-stage chronic heart failure. We studied the effect of body mass index (BMI), and the effect of subsequent weight change, on survival following transplantation in 1902 consecutive patients.


RESULTS
Patients were recruited from: London (n=553), Berlin (N=971) and Boston (N=378). Patients suitable for transplantation due to symptoms, low left ventricular ejection fraction (<or=30%) and peak oxygen consumption (<or=16 ml kg(-1) min(-1)) (N=237) were used as a comparator. In surviving transplanted patients, average duration of follow-up was 80 (SD 34) months. There were 805 deaths. One year survival was 72.7% (95% CI 72.68-72.72) and 5 year survival was 60.96% (61.94-61.99). Baseline BMI did not effect survival either as a continuous variable (hazard ratio (95% CI): 1.02; 0.99-1.04). Weight loss between transplant and 3 months was associated with worse survival (HR (95% CI) 2.6 (1.42-4.74)) compared with those who gained weight. In the reference group, increasing body mass index was related to survival.


CONCLUSIONS
Chronic heart failure patients with very low body weight can be transplanted successfully. The presence of underweight need not be an exclusion criterion for heart transplantation. Underweight patients appear to have a greater benefit from transplantation. Body weight increases after transplantation are not associated with adverse prognosis.
Clark
Andrew L
AL
Department of Cardiology, Univerity of Hull, and Department of Cardiac Surgery, Royal Brompton Hospital, London, UK. a.l.clark@hull.ac.uk
Knosalla
Christoph
C
Birks
Emma
E
Loebe
Matthias
M
Davos
Constantinos H
CH
Tsang
Sui
S
Negassa
Abdissa
A
Yacoub
Magdi
M
Hetzer
Roland
R
Coats
Andrew J S
AJ
Anker
Stefan D
SD
D000293:Adolescent; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D002100:Cachexia / Q000209:etiology; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000401:mortality* / Q000503:physiopathology / Q000601:surgery*; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D018579:Patient Selection; D011379:Prognosis; D013318:Stroke Volume; D016019:Survival Analysis; D015430:Weight Gain; D015431:Weight Loss