Sub-analysis
A sub-analysis was performed which included only patients that had been
waitlisted ≥90 days prior to OHT. This resulted in a total of 11,623
patients, 8,669 (74.6%) with stable weight, 1,262 (10.9%) with ≥5%
weight loss, and 1,692 (14.6%) with ≥5% weight gain. Ninety-day
(94.5% vs 92.9% vs 95.6%) and one-year (91.4% vs 88.9% vs 92.3%)
mortality were lowest in patients with ≥5% weight loss (Figure
3 ) (P =0.0044). In multivariable model, ≥5% weight loss was associated
with 33% increased hazards for posttransplant mortality (HR 1.33, 95%
CI 1.11 to 1.61, P=0.003). ≥5% weight gain was not found to have
significant impact on mortality (HR 0.87, 95% CI 0.72 to 1.06, P=0.173)
(Supplemental Table 2 ). When examined as a continuous variable,
decreasing weight was associated with increased hazards for mortality
(per 1% weight lost, HR 1.02, 95% CI 1.01 to 1.03, P<0.001)
(Supplemental Table 3 ). Other factors associated with increased
hazards for mortality included increasing BMI, congenital heart disease,
increasing total bilirubin and serum creatinine, pretransplant
mechanical ventilation, extracorporeal membrane oxygenation, increasing
donor age, and increasing graft cold ischemia time.
Additional sub-analysis investigated the outcomes of patients with
initial waitlist BMI ≥35 kg/m2. This subgroup was
comprised of 1,470 patients, 1,205 (82.0%) who were transplanted with a
BMI ≥ 35 kg/m2, and 265 (18.0%) who dropped to a BMI
< 35 kg/m2 prior to OHT. Comparison of
baseline characteristics are shown in SupplementalTable 4 . Patients who were transplanted at a BMI < 35
kg/m2 had a higher utilization of left ventricular
assist device as a bridge to OHT (66.9% vs 56.9%, P<0.001),
and also had a longer median waitlist time (397 days [IQR 172 to
727] vs 111 days [IQR 31 to 343], P<0.001) compared
those who were transplanted with a BMI ≥ 35 kg/m2.Figure 4a displays Kaplan Meier posttransplant survival between
groups. Additionally, recipients with waitlist BMI ≥ 35
kg/m2 were stratified into weight change while on
waitlist (stable weight, ≥5% weight loss, ≥5% weight), and Kaplan
Meier survival comparisons are shown in Figure 4b . In both
comparisons, there were no differences in one-year survival among
groups.