Study Implications
This study findings add to the growing knowledge regarding the complex
relationship between weight and heart failure. This study and others
have demonstrated higher pretransplant BMI to be associated with higher
risk of posttransplant mortality. However, we suggest that perhaps
examination of weight changes in the pretransplant period may offer
better prognostic potential than weight measurements alone. In this
study, we found an inverse relationship between pretransplant weight
loss and posttransplant mortality, with a 2% increase in risk-adjusted
hazards for mortality for every 1% of initial weight lost. Furthermore,
the impacts of pretransplant weight loss are likely the highest in
patients with lower initial BMI. Patients with ≥5% weight loss account
for 7.5% of all OHT recipients, and 11% of recipients who are
waitlisted for 90 or more days and represent a vulnerable and high-risk
subset. Further efforts are needed to identify these patients and
investigate the underlying mechanisms by which weight loss impact
long-term outcomes. Such understanding of these mechanism may help
promote future interventions such as patient-tailored nutritional
optimization prior to OHT.