Survival after orthotopic heart transplantation in patients with BMI > = 35 with and without diabetes. Issue 10 (3rd October 2021)

• Record Type: Journal Article
• Authors: Fiedler, Amy G.; Stalter, Lily; Marka, Nicholas; Dhingra, Ravi; Hermsen, Joshua L.; Smith, Jason W.
• Is Part Of: Clinical transplantation. Volume 35:Issue 10(2021)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2021-10-03
• Subjects: diabetes -- heart transplantation -- obesity -- UNOS; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ctr.14400
• Languages: English
• ISSNs: 0902-0063

Abstract

Abstract: 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.