Conclusions
In this analysis of 22,360 adult patients undergoing isolated OHT, we identified significant impacts of pretransplant weight changes on posttransplant outcomes. Patients with ≥5% loss in weight from time of OHT listing were found to have higher incidence of renal failure requiring dialysis and drug-treated acute rejection at one year. Furthermore, one-year survival was significantly reduced in comparison to recipients with stable pretransplant weight, and the negative effects of pretransplant weight loss are likely higher in patients with lower initial waitlist BMI levels. This cohort represents a small (7.5%), but high-risk subset of OHT recipients. As a result, efforts should be made to identify these at-risk patients and focus on nutritional optimization and weight loss prevention prior to OHT.