Survival after orthotopic heart transplantation in patients with BMI > = 35 with and without diabetes.
UNOS
diabetes
heart transplantation
obesity
Journal
Clinical transplantation
ISSN: 1399-0012
Titre abrégé: Clin Transplant
Pays: Denmark
ID NLM: 8710240
Informations de publication
Date de publication:
10 2021
10 2021
Historique:
revised:
25
05
2021
received:
24
03
2021
accepted:
16
06
2021
pubmed:
29
6
2021
medline:
3
2
2022
entrez:
28
6
2021
Statut:
ppublish
Résumé
Orthotopic heart transplant (OHT) recipients with a body mass index (BMI) > = 35 have worse survival than those with a BMI < 35. Diabetes is a risk factor for mortality. We evaluated the impact of diabetes on mortality rates after OHT in patients with a BMI > 35. Patients > 18 years who underwent OHT 2008-2017 with a BMI > = 35 were identified in the United Network for Organ Sharing (UNOS) database. Recipient and donor characteristics were compared. A Kaplan Meier analysis was performed. A multivariable Cox proportional hazards model examined the relationship between diabetes and survival. The equivalence of survival outcomes was examined by an unadjusted Cox proportional hazards model and the two one-sided test procedure, using a pre-specified equivalence region. Patients with diabetes were older, had a higher creatinine, lower bilirubin, fewer months on the waitlist, and the donor was less likely to be on inotropes. Kaplan-Meier analysis showed no difference in patient survival. Recipient factors associated with an increased risk of death were increasing bilirubin and machine ventilation. Increasing ischemic time resulted in an increased hazard of death. Long-term survival outcomes were equivalent. In OHT recipients with a BMI > 35, there is no statistical difference in longterm survival in recipients with or without diabetes. These results encourage continued consideration for OHT in patients BMI > 35 with coexisting diabetes.
Sections du résumé
BACKGROUND
Orthotopic heart transplant (OHT) recipients with a body mass index (BMI) > = 35 have worse survival than those with a BMI < 35. Diabetes is a risk factor for mortality. We evaluated the impact of diabetes on mortality rates after OHT in patients with a BMI > 35.
METHODS
Patients > 18 years who underwent OHT 2008-2017 with a BMI > = 35 were identified in the United Network for Organ Sharing (UNOS) database. Recipient and donor characteristics were compared. A Kaplan Meier analysis was performed. A multivariable Cox proportional hazards model examined the relationship between diabetes and survival. The equivalence of survival outcomes was examined by an unadjusted Cox proportional hazards model and the two one-sided test procedure, using a pre-specified equivalence region.
RESULTS
Patients with diabetes were older, had a higher creatinine, lower bilirubin, fewer months on the waitlist, and the donor was less likely to be on inotropes. Kaplan-Meier analysis showed no difference in patient survival. Recipient factors associated with an increased risk of death were increasing bilirubin and machine ventilation. Increasing ischemic time resulted in an increased hazard of death. Long-term survival outcomes were equivalent.
CONCLUSIONS
In OHT recipients with a BMI > 35, there is no statistical difference in longterm survival in recipients with or without diabetes. These results encourage continued consideration for OHT in patients BMI > 35 with coexisting diabetes.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e14400Informations de copyright
© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Références
Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. J Am Med Assoc. 2003;289(1):76-79.
Lavie CJ, Alpert MA, Arena R, Mehra MR, Milani RV, Ventura HO. Impact of obesity and the obesity paradox on prevalence and prognosis in heart failure. JACC Hear Fail. 2013.
Kilic A, Conte JV, Shah AS, Yuh DD. Orthotopic heart transplantation in patients with metabolic risk factors. Ann Thorac Surg. 2012;93(3):718-724.
De Lorenzo A, Gratteri S, Gualtieri P, Cammarano A, Bertucci P, Di Renzo L. Why primary obesity is a disease?. J Transl Med. 2019;17(1):169.
Hurt RT, Kulisek C, Buchanan LA, McClave SA. The obesity epidemic: challenges, health initiatives, and implications for gastroenterologists. Gastroenterol Hepatol. 2010.
Musci M, Loforte A, Potapov EV, et al. Body mass index and outcome after ventricular assist device placement. Ann Thorac Surg. 2008. https://doi.org/10.1016/j.athoracsur.2008.05.044.
O'horo JC, Abu Saleh OM, Stulak JM, Wilhelm MP, Baddour LM, Rizwan S M. Left ventricular assist device infections: a systematic review. ASAIO J. 2018. https://doi.org/10.1097/MAT.0000000000000684.
Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2016. https://doi.org/10.1093/eurheartj/ehw128.
Gao M, Sun J, Young N, et al. Impact of body mass index on outcomes in cardiac surgery. J Cardiothorac Vasc Anesth. 2016. https://doi.org/10.1053/j.jvca.2016.03.002.
Johnson AP, Parlow JL, Whitehead M, Xu J, Rohland S, Milne B. Body mass index, outcomes, and mortality following cardiac surgery in Ontario, Canada. J Am Heart Assoc. 2015. https://doi.org/10.1161/JAHA.115.002140.
Doumouras BS, Fan C-PS, Mueller B, et al. The effect of pre-heart transplant body mass index on posttransplant outcomes: an analysis of the ISHLT Registry Data. Clin Transplant. 2019. https://doi.org/10.1111/ctr.13621.
Russo MJ, Hong KN, Davies RR, et al. The effect of body mass index on survival following heart transplantation: do outcomes support consensus guidelines?. Ann Surg. 2010. https://doi.org/10.1097/SLA.0b013e3181b5db3c.