Faculty Collaboration Database

Survival after orthotopic heart transplantation in patients with BMI > = 35 with and without diabetes. Clin Transplant 2021 Oct;35(10):e14400

Date

06/29/2021

Pubmed ID

34181771

DOI

10.1111/ctr.14400

Scopus ID

2-s2.0-85116141333 (requires institutional sign-in at Scopus site)   4 Citations

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.

Author List

Fiedler AG, Stalter L, Marka N, Dhingra R, Hermsen JL, Smith JW

Author

Ravi Dhingra MBBS Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Body Mass Index
Diabetes Mellitus
Heart Transplantation
Humans
Kaplan-Meier Estimate
Proportional Hazards Models
Retrospective Studies
Survival Rate
Treatment Outcome
Waiting Lists