The impact of pre-transplant weight loss on survival following cardiac transplantation.
cachexia
cardiac transplant
nutrition
Journal
Clinical transplantation
ISSN: 1399-0012
Titre abrégé: Clin Transplant
Pays: Denmark
ID NLM: 8710240
Informations de publication
Date de publication:
12 2022
12 2022
Historique:
revised:
07
09
2022
received:
04
08
2022
accepted:
24
09
2022
pubmed:
23
10
2022
medline:
27
12
2022
entrez:
22
10
2022
Statut:
ppublish
Résumé
Significant weight loss due to cardiac cachexia is an independent predictor of mortality in many heart failure (HF) clinical trials. The impact of significant weight loss while on the waitlist for heart transplant (HT) has yet to be studied with respect to post-transplant survival. Adult HT recipients from 2010 to 2021 were identified in the UNOS registry. Patients who experienced an absolute weight change from the time of listing to transplant were included and classified into two groups by percent weight loss from time of listing to time of transplant using a cut-off of 10%. The primary endpoint was 1-year survival following HT. 5951 patients were included in the analysis, of whom 763 (13%) experienced ≥10% weight loss from the time of listing to transplant. Weight loss ≥ 10% was associated with reduced 1-year post-transplant survival (86.9% vs. 91.0%, long-rank p = .0003). Additionally, weight loss ≥ 10% was an independent predictor of 1-year mortality in a multivariable model adjusting for significant risk factors (adjusted HR 1.23, 95% CI 1.04-1.46). In secondary analyses, weight loss ≥ 10% was associated with reduced 1-year survival independent of hospitalized status at time of transplant as well as obesity status at listing (i.e., body mass index [BMI] < 30 kg/m Preoperative weight loss ≥ 10% is associated with reduced survival in patients listed for HT. Nutrition interventions prior to transplant may prove beneficial in this population.
Sections du résumé
BACKGROUND
Significant weight loss due to cardiac cachexia is an independent predictor of mortality in many heart failure (HF) clinical trials. The impact of significant weight loss while on the waitlist for heart transplant (HT) has yet to be studied with respect to post-transplant survival.
METHODS
Adult HT recipients from 2010 to 2021 were identified in the UNOS registry. Patients who experienced an absolute weight change from the time of listing to transplant were included and classified into two groups by percent weight loss from time of listing to time of transplant using a cut-off of 10%. The primary endpoint was 1-year survival following HT.
RESULTS
5951 patients were included in the analysis, of whom 763 (13%) experienced ≥10% weight loss from the time of listing to transplant. Weight loss ≥ 10% was associated with reduced 1-year post-transplant survival (86.9% vs. 91.0%, long-rank p = .0003). Additionally, weight loss ≥ 10% was an independent predictor of 1-year mortality in a multivariable model adjusting for significant risk factors (adjusted HR 1.23, 95% CI 1.04-1.46). In secondary analyses, weight loss ≥ 10% was associated with reduced 1-year survival independent of hospitalized status at time of transplant as well as obesity status at listing (i.e., body mass index [BMI] < 30 kg/m
CONCLUSIONS
Preoperative weight loss ≥ 10% is associated with reduced survival in patients listed for HT. Nutrition interventions prior to transplant may prove beneficial in this population.
Identifiants
pubmed: 36271917
doi: 10.1111/ctr.14831
pmc: PMC9984247
mid: NIHMS1874165
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e14831Subventions
Organisme : NHLBI NIH HHS
ID : K23 HL148528
Pays : United States
Informations de copyright
© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Références
Clin Res Cardiol. 2022 Apr;111(4):451-459
pubmed: 34757487
ESC Heart Fail. 2021 Dec;8(6):5293-5303
pubmed: 34599855
J Heart Lung Transplant. 2016 Jan;35(1):1-23
pubmed: 26776864
Nat Rev Cardiol. 2017 Jun;14(6):323-341
pubmed: 28436486
Eur J Heart Fail. 2020 Dec;22(12):2314-2326
pubmed: 32949422
Eur Heart J. 2008 Nov;29(21):2641-50
pubmed: 18819960
Curr Heart Fail Rep. 2013 Dec;10(4):307-14
pubmed: 23925442
JACC Heart Fail. 2013 Apr;1(2):93-102
pubmed: 24621833
Eur J Heart Fail. 2015 Apr;17(4):424-33
pubmed: 25704364
Lancet. 2003 Mar 29;361(9363):1077-83
pubmed: 12672310
Clin Transplant. 2019 Jul;33(7):e13621
pubmed: 31152559
Curr Probl Cardiol. 2020 Nov;45(11):100417
pubmed: 31036371
JAMA Netw Open. 2021 Jan 4;4(1):e2033433
pubmed: 33471118
J Cachexia Sarcopenia Muscle. 2011 Sep;2(3):135-142
pubmed: 21966640