Limitations
This study was subject to limitations. First, this was a retrospective
study and thus subject to selection bias that true randomization would
eliminate. It is possible that pretransplant weight loss may serve as a
surrogate for other disease processes and illness that influence
posttransplant outcomes. In order to adjust for these possible
confounding variables, we performed a multivariable analysis to adjust
for pretransplant risk factors that were found to have influence on
posttransplant mortality. However, it is possible that further
unmeasured variables exist and may influence the findings of this study.
Additionally, we recognize that weight changes are gradual, and patients
who are transplanted after short waitlisting times are not likely to
experience significant weight change. To address this, we performed a
secondary analysis and included only patients who were waitlisted at
least 90 days prior transplantation. Finally, we cannot determine from
this analysis if weight loss was intentional or unintentional, or how
volume overload and subsequent diuresis may have impacted our
categorization.