Study Design
In this study, we included adult patients (≥18 years) who underwent
isolated, primary OHT within the study period. Multi-visceral
transplants and heterotopic heart transplants were excluded. Percent
waitlist weight change was calculated from time of OHT waitlisting to
time of transplant. Recipients were then divided into three cohorts,
those with ≥5% weight loss while waitlisted, those with stable weight
(<|5%| weight change), and those with ≥5%
weight gain. Patient demographic and outcomes data were collected from
the UNOS database.
The primary outcome of this study was one-year posttransplant survival.
Other outcomes included postoperative complications, hospital length of
stay, and rates of drug-treated one-year acute rejection. Predictors of
posttransplant mortality and were modeled in multivariable analysis.
Because patients with short waitlist times are unlikely to experience
significant fluctuations in weight, we performed a sub-analysis. In this
analysis, we excluded patients with waitlist times <90 days.
One-year survival was compared among cohorts, and multivariable modeling
for mortality was performed in this population. Furthermore, as many
transplanting centers focus on waitlisted candidates achieving a BMI
less than 35 kg/m2 prior to transplantation, we
performed a separate sub-analysis to investigate outcomes of patients
with initial waitlist BMI ≥ 35 kg/m2.