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Waitlist Weight Changes Impact Survival Following Heart Transplantation
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  • Nicholas Hess,
  • Ryan Tedford,
  • Brian Houston,
  • Nicolas Pope,
  • Lucas Witer,
  • Marc Katz,
  • Arman Kilic
Nicholas Hess
University of Pittsburgh Medical Center
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Ryan Tedford
Medical University of South Carolina - College of Medicine
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Brian Houston
Medical University of South Carolina - College of Medicine
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Nicolas Pope
Medical University of South Carolina - College of Medicine
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Lucas Witer
Medical University of South Carolina - College of Medicine
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Marc Katz
Medical University of South Carolina - College of Medicine
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Arman Kilic
University of Pittsburgh Medical Center Health System
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Abstract

Background: This study investigated the impact of weight change in waitlisted candidates on posttransplant outcomes following orthotopic heart transplantation (OHT). Methods: The United Network for Organ Sharing database was queried to identify adult patients undergoing isolated, primary OHT from 1/1/2010 to 3/20/2020. Patients were stratified into 3 cohorts based on percent weight change from listing to OHT. The primary outcome was one-year survival, and multivariable modeling was used for risk-adjustment. A secondary analysis compared outcomes of recipients waitlisted ≥90 days. Results: A total of 22,360 patients were included, 18,826 (84.2%) with stable weight, 1,672 (7.5%) with ≥5% weight loss, and 1,862 (8.3%) with ≥5% weight gain. Median age was similar across cohorts. Waitlist time was longest in patients with weight gain and shortest in those with stable weight (417 vs 74 days, P<0.001). The weight loss cohort had higher rates of dialysis dependency, pacemaker, and drug-treated acute rejection at one year (all P<0.05). Ninety-day and one-year posttransplant survival was lowest in the weight loss cohort. Multivariable modeling identified both ≥5% weight loss (HR 1.26, 95% CI 1.07-1.48) and decreasing weight (per 1%, HR 1.02, 95% CI 1.01-1.03) as risk-adjusted predictors of one-year mortality. In sub-analysis of recipients waitlisted ≥90 days, ≥5% weight loss and decreasing weight remained significant independent predictors for mortality. Conclusion: Waitlisted OHT candidates with ≥5% weight loss comprised a small, but higher-risk population with increased rates of postoperative complications and decreased survival. Efforts focused on nutritional optimization and preventing weight loss while awaiting OHT appear warranted.

Peer review status:IN REVISION

19 Jan 2021Submitted to Journal of Cardiac Surgery
20 Jan 2021Assigned to Editor
20 Jan 2021Submission Checks Completed
24 Jan 2021Reviewer(s) Assigned
12 Feb 2021Review(s) Completed, Editorial Evaluation Pending
17 Feb 2021Editorial Decision: Revise Major