Introduction
Orthotopic heart transplantation (OHT) remains the gold standard
treatment for advanced, end-stage heart failure1. As
efforts have focused on improving outcomes following OHT, much research
has aimed at identifying modifiable risk factors that impact
posttransplant outcomes. Of these, recipient weight and body composition
have become of interest. The relationship between weight and heart
failure are complex, as obesity is simultaneously a risk factor for the
development of heart failure and a favorable prognostic marker in
patients with existing heart failure2. In the OHT
population, general consensus has recommended candidates achieve a body
mass index (BMI) of <35-38 to prevent worse
outcomes3,4. In some instances, OHT candidates may
even undergo bariatric surgery in order to meet this BMI goal and
increase chances of transplantation5,6. Although
higher pretransplant BMI may be associated with longer waitlist times,
several studies have questioned whether increased BMI actually impacts
posttransplant outcomes7–9.
While the impact of pre-OHT BMI remains controversial, even less is
understood about the significance of weight changes on these outcomes.
Among lung transplant recipients, pretransplant weight loss and BMI
reduction, regardless of initial weight, has been shown to be associated
with improved outcomes and survival10,11. However, it
is unknown if these findings are applicable in the heart failure
population. In this study, we aim to investigate the impacts of
pretransplant weight changes on posttransplant outcomes following OHT.