Introduction
Orthotopic heart transplantation (OHT) remains the gold standard treatment for advanced, end-stage heart failure1. As efforts have focused on improving outcomes following OHT, much research has aimed at identifying modifiable risk factors that impact posttransplant outcomes. Of these, recipient weight and body composition have become of interest. The relationship between weight and heart failure are complex, as obesity is simultaneously a risk factor for the development of heart failure and a favorable prognostic marker in patients with existing heart failure2. In the OHT population, general consensus has recommended candidates achieve a body mass index (BMI) of <35-38 to prevent worse outcomes3,4. In some instances, OHT candidates may even undergo bariatric surgery in order to meet this BMI goal and increase chances of transplantation5,6. Although higher pretransplant BMI may be associated with longer waitlist times, several studies have questioned whether increased BMI actually impacts posttransplant outcomes7–9.
While the impact of pre-OHT BMI remains controversial, even less is understood about the significance of weight changes on these outcomes. Among lung transplant recipients, pretransplant weight loss and BMI reduction, regardless of initial weight, has been shown to be associated with improved outcomes and survival10,11. However, it is unknown if these findings are applicable in the heart failure population. In this study, we aim to investigate the impacts of pretransplant weight changes on posttransplant outcomes following OHT.