title: Adult candidates for heart transplantation with larger body surface area have better prognosis on waiting list after progression to critically ill status.
abstract: OBJECTIVE
  Smaller body size is one of the characteristics of female patients. We analyzed whether lower body surface area (BSA) of adult patients affects their prognosis after listing for heart transplantation (HTx).
  
  
  METHODS
  Adult candidates (≥ 18 and <65 years) for de novo HTx in our center, who were newly listed as T (transplantable) by Eurotransplant without ventricular assist device (VAD) support between 2000 and 2009 (n = 545), were studied. The patients were divided into two groups: group S (n = 272): BSA<1.9563 m(2) (median value of total patients) and group L (n = 273): BSA ≥ 1.9563 m(2). Most female patients (82/84, 97.6%) belong to group S. Among all these patients, 286 progressed to critically ill status, that is, they were listed in urgent status or received a VAD. Actuarial survival rates were studied in each group.
  
  
  RESULTS
  Overall survival rates after listing for HTx in group S were comparable to those in group L (43.0% vs 43.7% for 7-year survival, p=0.95). However, 1-year survival rate on waiting list after progression to critically ill status in group S (58.0%, n = 135) and that of female patients in group S (55.8%, n = 33) were significantly lower than those in group L (67.3%, n = 151, all were men; p = 0.042 and p = 0.044, respectively). After multivariate Cox analysis, BSA<1.9563 m(2) (hazard ratio 2.120, p = 0.0019), serum creatinine (hazard ratio 1.202, p = 0.033), obesity defined as body mass index ≥ 30 kg m(-2) (hazard ratio 2.043, p = 0.0096) and primary use of VAD (hazard ratio 3.243, p < 0.0001) were identified as independent risk factors for mortality on waiting list after progression to critically ill status. One-year survival rate on waiting list after VAD implantation in group S (44.4%, n = 65) and that of female patients in group S (38.1%, n = 14) were significantly lower than those in group L (63.0%, n = 78, all were men; p = 0.020 and p = 0.012, respectively).
  
  
  CONCLUSIONS
  Adult HTx candidates with lower BSA, including most women, had worse prognosis on waiting list after progression to critically ill status, especially after VAD implantation. As almost all HTx are nowadays performed in critical status, this problem has emerged as important.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. komoda@dhzb.de
authors.forename: Takeshi
authors.initials: T
authors.lastname: Komoda
authors.forename: Thorsten
authors.initials: T
authors.lastname: Drews
authors.forename: Roland
authors.initials: R
authors.lastname: Hetzer
authors.forename: Hans B
authors.initials: HB
authors.lastname: Lehmkuhl
mesh_terms: D000328:Adult; D001830:Body Surface Area; D002302:Cardiac Output; D018450:Disease Progression; D004812:Epidemiologic Methods; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000601:surgery*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013318:Stroke Volume; D014850:Waiting Lists; D055815:Young Adult