title: Pre-transplant obesity in heart transplantation: are there predictors of worse outcomes?
abstract: OBJECTIVE
  Morbid obesity is increasingly observed in patients being evaluated for heart transplantation and represents a relative contraindication. We sought to evaluate the influence of pre-transplant obesity on morbidity and mortality after heart transplantation.
  
  
  METHODS
  We retrospectively reviewed 90 consecutive patients with preoperative obesity (BMI > or = 30) and 90 age matched patients with normal weight (BMI 19 - 26) who underwent heart transplantation at our institution between January 1997 and December 2005.
  
  
  RESULTS
  Morbidly obese patients experienced higher rates of pre-transplant diabetes (29% vs 15%, p < 0.05) and prolonged waiting time before transplantation (191.4+/-136.1 vs 117.4+/-143.2 days, p < 0.001). There were no significant differences in post-operative complications including rejection and major and minor infections. There was no difference in actuarial survival between the obese and control groups after a mean follow-up of 4.26+/-2.95 years (p = 0.513, log-rank statistic 0.452). Causes of death did not differ. Cox proportional hazard analysis revealed increased association of peripheral vascular disease (HR 31.718, p = 0.001), and pre operative inotropic support (HR 33.725, p = 0.013) with increased mortality in the obese group.
  
  
  CONCLUSIONS
  This study suggests morbid obesity does not affect survival or rates of infection and rejection after heart transplantation.
authors.affiliation: Division of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, MI, USA. mmacha@med.umich.edu
authors.forename: Mahender
authors.initials: M
authors.lastname: Macha
authors.forename: Ezequiel J
authors.initials: EJ
authors.lastname: Molina
authors.forename: Michael
authors.initials: M
authors.lastname: Franco
authors.forename: Lisa
authors.initials: L
authors.lastname: Luyun
authors.forename: John P
authors.initials: JP
authors.lastname: Gaughan
authors.forename: James B
authors.initials: JB
authors.lastname: McClurken
authors.forename: Satoshi
authors.initials: S
authors.lastname: Furukawa
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D005260:Female; D006084:Graft Rejection / Q000209:etiology; D006085:Graft Survival; D006333:Heart Failure / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications* / Q000401:mortality; D015143:Philadelphia; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists