Study Implications
This study findings add to the growing knowledge regarding the complex relationship between weight and heart failure. This study and others have demonstrated higher pretransplant BMI to be associated with higher risk of posttransplant mortality. However, we suggest that perhaps examination of weight changes in the pretransplant period may offer better prognostic potential than weight measurements alone. In this study, we found an inverse relationship between pretransplant weight loss and posttransplant mortality, with a 2% increase in risk-adjusted hazards for mortality for every 1% of initial weight lost. Furthermore, the impacts of pretransplant weight loss are likely the highest in patients with lower initial BMI. Patients with ≥5% weight loss account for 7.5% of all OHT recipients, and 11% of recipients who are waitlisted for 90 or more days and represent a vulnerable and high-risk subset. Further efforts are needed to identify these patients and investigate the underlying mechanisms by which weight loss impact long-term outcomes. Such understanding of these mechanism may help promote future interventions such as patient-tailored nutritional optimization prior to OHT.