Limitations
This study was subject to limitations. First, this was a retrospective study and thus subject to selection bias that true randomization would eliminate. It is possible that pretransplant weight loss may serve as a surrogate for other disease processes and illness that influence posttransplant outcomes. In order to adjust for these possible confounding variables, we performed a multivariable analysis to adjust for pretransplant risk factors that were found to have influence on posttransplant mortality. However, it is possible that further unmeasured variables exist and may influence the findings of this study. Additionally, we recognize that weight changes are gradual, and patients who are transplanted after short waitlisting times are not likely to experience significant weight change. To address this, we performed a secondary analysis and included only patients who were waitlisted at least 90 days prior transplantation. Finally, we cannot determine from this analysis if weight loss was intentional or unintentional, or how volume overload and subsequent diuresis may have impacted our categorization.