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The Effect of Pre-Heart Transplant Obesity on Post-Transplant Mortality: An Analysis of the ISHLT Registry Data
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The Journal of Heart and Lung Transplantation, Vol 36, No 4S, April 2017 Results: A total of 48,952 patients were included. The median (inter-quartile range) age at primary transplant was 54 (43-60) years, and 24% of patients were female. During a median follow-up of 4 (1-8) years, 15,935 (32.6%) recipients died. Survival at ten years was 55.5% for underweight, 58.9% for normal BMI, 56.8% for overweight, 52.1% for obesity class I, 53.9% for obesity class II, and 47.1% for obesity class III patients (p< 0.001). By multivariable analysis, obesity was associated with significantly higher posttransplant mortality risk in comparison to other patients (Class I HR 1.12, 95% CI 1.07-1.17; Class II HR 1.06, 95% CI 0.98-1.16; Class III HR 1.38, 95% CI 1.12-1.69). Assessing cause-specific mortality, death due to cardiac allograft vasculopathy (p= 0.03) and acute (p= 0.04) and chronic (p< 0.001) rejection were increased in obese patients, while death due to stroke and myocardial infarction were not. Conclusion: Our study suggests that obese (BMI> 30kg/m2) heart transplant recipients are at increased risk of post-transplant mortality. The risk associated with high BMI should be taken into account at the time of transplant assessment. 4( 88) Young African American Heart Transplant Recipients Have an Elevated Risk of Post-Transplant Mortality H. Maredia ,1 M. Bowring,1 A. Massie,1 S. Oyetunji,1 C. Merlo,2 R. Higgins,1 D. Segev,1 E. Bush.1 1Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; 2Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
4( 87) The Effect of Pre-Heart Transplant Obesity on Post-Transplant Mortality: An Analysis of the ISHLT Registry Data B.S. Doumouras ,1 C.S. Fan,2 A.I. Dipchand,3 C. Manlhiot,2 J. Stehlik,4 H.J. Ross,1 A.C. Alba.1 1Heart Failure and Transplant Program, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; 2CV Data Management Centre, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; 3Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; 4University of Utah School of Medicine, Salt Lake City, UT. Purpose: Due to the paucity of available organs, optimal recipient selection for heart transplantation is necessary to derive maximal benefit. Currently, there is no firm consensus on whether obesity is a contraindication to heart transplantation. Our aim was to evaluate the effect of increased body mass index (BMI) on post-transplant mortality in heart transplant recipients. Methods: We utilized data from the International Society for Heart and Lung Transplantation Transplant Registry between 2000 and 2014. Adult and adolescent patients (age > 14 years) who underwent heart transplant were included. Recipients who underwent re-transplant or simultaneous organ transplant were excluded. The patients were stratified based on pretransplant BMI (kg/m2): < 18.5 (underweight), 18.5-24.99 (normal), 25-29.99 (overweight), 30-34.99 (obesity class I), 35-39.99 (obesity class II), and > 40 (obesity class III). We used Kaplan-Meier analysis and multivariable Cox proportional hazard regression model to evaluate the association of BMI with all-cause and cause-specific post-transplant mortality.
Purpose: African American (AA) race is associated with poorer survival among heart transplant recipients. We examined racial disparities in survival post-heart transplant and explored the potential effect modification of age and race on survival. Methods: Using SRTR, we performed a retrospective observational study of 29,039 adult heart transplant recipients from 1/1/2000-3/3/2016, comparing post-transplant survival in African-American (AA) vs non-AA recipients stratified by age (18-30, 31-40, 41-60 and 61-80). Cox regression was used to compare mortality by race with age as an effect modifier after adjusting for recipient and donor characteristics. Results: AA recipients were older at transplant than non-AA recipients, with median age of (IQR) 51 (40-58) vs 56 (48-62) years (ranksum p< 0.001). In an adjusted model, AA recipients had a 17% higher risk of death than comparable non-AA candidates (aHR = 1.061.171.31, p= 0.003). Survival differed significantly across age categories among both AA and non-AA recipients (Figure; both logrank p< 0.001). The association between AA race and mortality was amplified among younger recipients (p< 0.001 for race/age interaction). Among recipients aged 18-30, AA were at a 1.602.032.59 times higher risk of death relative to non-AA recipients; however, among recipients aged 61-80, AA recipients were at a 1.041.221.44 times higher risk of death compared to non-AA (Table). Conclusion: Young AA recipients aged 18-30 years had the highest risk of death post-transplant relative to other age and race groups. Identifying age as an effect modifier of racial disparities will provide better prognostication for transplant candidates and inform improved surveillance of young AA recipients.
The Journal of Heart and Lung Transplantation, Vol 36, No 4S, April 2017 Results: A total of 48,952 patients were included. The median (inter-quartile range) age at primary transplant was 54 (43-60) years, and 24% of patients were female. During a median follow-up of 4 (1-8) years, 15,935 (32.6%) recipients died. Survival at ten years was 55.5% for underweight, 58.9% for normal BMI, 56.8% for overweight, 52.1% for obesity class I, 53.9% for obesity class II, and 47.1% for obesity class III patients (p< 0.001). By multivariable analysis, obesity was associated with significantly higher posttransplant mortality risk in comparison to other patients (Class I HR 1.12, 95% CI 1.07-1.17; Class II HR 1.06, 95% CI 0.98-1.16; Class III HR 1.38, 95% CI 1.12-1.69). Assessing cause-specific mortality, death due to cardiac allograft vasculopathy (p= 0.03) and acute (p= 0.04) and chronic (p< 0.001) rejection were increased in obese patients, while death due to stroke and myocardial infarction were not. Conclusion: Our study suggests that obese (BMI> 30kg/m2) heart transplant recipients are at increased risk of post-transplant mortality. The risk associated with high BMI should be taken into account at the time of transplant assessment. 4( 88) Young African American Heart Transplant Recipients Have an Elevated Risk of Post-Transplant Mortality H. Maredia ,1 M. Bowring,1 A. Massie,1 S. Oyetunji,1 C. Merlo,2 R. Higgins,1 D. Segev,1 E. Bush.1 1Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; 2Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
4( 87) The Effect of Pre-Heart Transplant Obesity on Post-Transplant Mortality: An Analysis of the ISHLT Registry Data B.S. Doumouras ,1 C.S. Fan,2 A.I. Dipchand,3 C. Manlhiot,2 J. Stehlik,4 H.J. Ross,1 A.C. Alba.1 1Heart Failure and Transplant Program, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; 2CV Data Management Centre, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; 3Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; 4University of Utah School of Medicine, Salt Lake City, UT. Purpose: Due to the paucity of available organs, optimal recipient selection for heart transplantation is necessary to derive maximal benefit. Currently, there is no firm consensus on whether obesity is a contraindication to heart transplantation. Our aim was to evaluate the effect of increased body mass index (BMI) on post-transplant mortality in heart transplant recipients. Methods: We utilized data from the International Society for Heart and Lung Transplantation Transplant Registry between 2000 and 2014. Adult and adolescent patients (age > 14 years) who underwent heart transplant were included. Recipients who underwent re-transplant or simultaneous organ transplant were excluded. The patients were stratified based on pretransplant BMI (kg/m2): < 18.5 (underweight), 18.5-24.99 (normal), 25-29.99 (overweight), 30-34.99 (obesity class I), 35-39.99 (obesity class II), and > 40 (obesity class III). We used Kaplan-Meier analysis and multivariable Cox proportional hazard regression model to evaluate the association of BMI with all-cause and cause-specific post-transplant mortality.
Purpose: African American (AA) race is associated with poorer survival among heart transplant recipients. We examined racial disparities in survival post-heart transplant and explored the potential effect modification of age and race on survival. Methods: Using SRTR, we performed a retrospective observational study of 29,039 adult heart transplant recipients from 1/1/2000-3/3/2016, comparing post-transplant survival in African-American (AA) vs non-AA recipients stratified by age (18-30, 31-40, 41-60 and 61-80). Cox regression was used to compare mortality by race with age as an effect modifier after adjusting for recipient and donor characteristics. Results: AA recipients were older at transplant than non-AA recipients, with median age of (IQR) 51 (40-58) vs 56 (48-62) years (ranksum p< 0.001). In an adjusted model, AA recipients had a 17% higher risk of death than comparable non-AA candidates (aHR = 1.061.171.31, p= 0.003). Survival differed significantly across age categories among both AA and non-AA recipients (Figure; both logrank p< 0.001). The association between AA race and mortality was amplified among younger recipients (p< 0.001 for race/age interaction). Among recipients aged 18-30, AA were at a 1.602.032.59 times higher risk of death relative to non-AA recipients; however, among recipients aged 61-80, AA recipients were at a 1.041.221.44 times higher risk of death compared to non-AA (Table). Conclusion: Young AA recipients aged 18-30 years had the highest risk of death post-transplant relative to other age and race groups. Identifying age as an effect modifier of racial disparities will provide better prognostication for transplant candidates and inform improved surveillance of young AA recipients.