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.